Hemodynamic vertebrobasilar insufficiency as an adverse effect of antihypertensive therapy.
A 63-year-old white male with a 25-year history of hypertension experienced the onset of intermittent diplopia and gait disturbance 24 hours after a change in antihypertensive medication from atenolol 50 mg/d to enalapril 5 mg bid. Three weeks later, the patient was admitted with a worsening of symptoms. Cerebral arteriography revealed significant bilateral vertebral artery stenosis. Symptoms continued to progress in the hospital, and at the time of posterior circulation revascularization the patient had a persistent bilateral internuclear ophthalmoplegia and right ptosis. The need for a neurovascular workup and adjustment of therapy in patients with antihypertensive-associated cerebral ischemia is discussed.
Fagan
S C
SC
College of Pharmacy, Wayne State University, Detroit, MI 48202.
McCormick
P W
PW
Diaz
F G
FG
D000959:Antihypertensive Agents / Q000009:adverse effects*; D001262:Atenolol / Q000009:adverse effects*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004656:Enalapril / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014715:Vertebrobasilar Insufficiency / Q000139:chemically induced* / Q000503:physiopathology
D000959:Antihypertensive Agents; D001262:Atenolol; D004656:Enalapril