(a) Changes in size and breadth of the retinal arteries so that they look beaded,
(b) Distinct loss of translucency,
(c) Alternate contractions and dilatations in the veins,
(d) Most important of all, the indentation of the veins by the stiffened arteries.
There is yet another sign which appears to be pathognomonic. The arteries are pale, appear rigid and through the center, parallel to the course, is a rather bright, fine threadlike line. The appearance is known as the "silverwire" artery. It is particularly constant in hypertension where the most beautiful examples are seen.
Moreover, there is the arcus senilis, the fine translucent to opaque circle surrounding the outer portion of the iris. Practically every one with a well-marked arcus senilis has arteriosclerosis, but vice versa not every one with even marked arteriosclerosis has an arcus senilis.
In general, the symptoms are gradual loss of acute vision, and attacks of transient loss of vision. The explanation which has been offered for these phenomena is the contraction in a diseased central artery.
Nervous Symptoms
The onset of arteriosclerosis is, in the majority of cases, so insidious that certain nervous manifestations, due in all probability to disturbances in blood pressure, are present long before the actual sclerosis of the arteries can be felt. These nervous symptoms are at times the sign posts to show us the way to accurate diagnosis. There may be gradual increase in irritability of temper, inability to sleep, vertigo even extending to transient attacks of unconsciousness. Loss of memory for details frequently is an early symptom of sclerosis of the cerebral arteries. Nervous indigestion may be present. Various paresthesias as numbness, tingling, a sense of coldness or of heat or burning, a sense of stiffness or even actual stiffness or weakness may occur in the arms and legs, more frequently in the legs. The pain complained of may be due to occlusion of an artery, although evidence for this is lacking. It has been thought by some that the pain in angina pectoris might be due to this cause.
Several curious and interesting diseases which have been thought by some to have arteriosclerosis as a basis are accompanied by pain. Such are erythromelalgia, Raynaud's disease, "dead fingers," and intermittent claudication.