The attacks of pain from which this patient suffered for many years, the hypertrophy of the left ventricle and the increased blood pressure were thought to be directly due to the sclerosis of the abdominal vessels.
Cerebral
It has been stated that arteriosclerosis is a general disease, yet certain systems of vessels may be affected far more than others, and indeed there may be marked sclerosis at one part of the body and none demonstrable at another part.
In advanced sclerosis there may be one or more of a series of accidents due to embolism, thrombosis, or rupture of the vessels. Such conditions as transient hemiplegia, monoplegia or aphasia may occur. The attacks may come on suddenly and be over in a few minutes; what Allbutt calls "Larval apoplexies." They may last from a few hours up to a day, and are very characteristic. A patient aged 64 years with pipe stem radials and tortuous hard temporals would be lying quietly in bed when suddenly he would stiffen, the eyes would become fixed and the breathing cease. In a few seconds consciousness returned, the patient would shake himself, pass his hand over his brow and ask, "Where am I? Oh, yes, that's all right." He had as many as thirty of these attacks in twenty-four hours, none of them lasting over one minute. To just what such attacks are due, it is hard to say. Some have attributed them to spasm of the smaller blood vessels of the brain, but there have never been demonstrated in the vessels any constrictor fibers.
There is a well recognized form of dementia caused by arteriosclerosis. In general paralysis of the insane and in senile dementia the blood vessels are always diseased. Milder grades of psychic disturbances are accompanied by such symptoms as mental fatigue, persistent headaches, vertigo, memory weakness and fainting. Aphasia, periods of excitement and mental confusion occur in some. Later stages are at times accompanied by inclination to fabulate, loss of judgment, disorientation, narrowing of the external interests, episodes of confusion and hallucinatory delirium.
The hemiplegias, monoplegias and paraplegias may occur again and again and last for one or two days. Unless there has been rupture of the vessels, there is complete recovery as a rule.
In persons who have arteriosclerosis with high tension attacks of melancholia are seen. There are at the same time fits of depression, insomnia, irritability, fretfulness, and a generally marked change in disposition. When the tension is reduced by appropriate treatment these symptoms disappear, to recur when the tension again becomes high. On the contrary, attacks of mania are accompanied by low blood pressure. The dizziness and vertigo in cerebral arteriosclerosis are probably due to the stiffness of the vessels which prevents them from following closely the variations of pressure produced by position, and thus, at times, the brain is deprived of blood and a transient anemia occurs.
Arteriosclerosis of the cerebral vessels is always a serious condition. The greatest danger is from rupture of a blood vessel. Another of the dangers is gradual occlusion of the arteries bringing about necrosis with softening of the brain substance. The latter is more apt to be associated with psychic changes, dementia, etc.; the former, with hemiplegia. It is curious that a small branch of the Sylvian artery, the lenticulo-striate, which supplies the corpus striatum, should be the one which most frequently ruptures. Where the motor fibers from the whole cortex are gathered together in one compact bundle, a very small hemorrhage may and does cause very serious effects. A comparatively large hemorrhage in the silent area of the brain may cause few or no symptoms.
Spinal
It is conceivable that arteriosclerosis of the vessels of the spinal cord might cause symptoms which would be referred to the areas of the cord where the process was most advanced. The lesions would be scattered and consequently the symptoms might be protean in character.