Embolism

“ An embolism on the contrary is a disease of the arteries since in these the blood current, proceeding centrifugally from the greater to the lesser, inevitably carries the moving solid to a point too narrow to allow of its further progress. ”

“ An embolus is a foreign body in a blood-vessel, usually too large to pass through the smallest capillaries, and the disturbances resulting from its presence are included under the term embolism. Although most emboli are detached portions of thrombi, any foreign body of suitable size may become an embolus. Such are tissues, as the pulmonary elastic fibres, fragments of diseased valves of the heart and of the intima of arteries, or portions of tumors growing into vascular canals. ”

“ As to its origin in the form of fibrinous deposit on the valves of the heart or a roughened spot on the aorta, we must refer to the article on General Pathology. The most important [p. 951] condition for embolism is disease of the valves of the heart, rheumatic or otherwise. Next comes arterial disease, producing roughening of the inner coat and subsequent deposition of fibrin. ”

“ Percussion and auscultation may remain negative. The patient may have a succession of similar accidents, and yet finally recover. According to Ball, pulmonary embolism and pulmonary thrombosis cannot be distinguished during life. In one case which he reports where pulmonary embolism should have been present without question the autopsy showed the presence of a thrombus in the pulmonary artery. A succession of chills, general malaise, febrile excitement, the localized phenomena of pneumonia or gangrene of the lung, point indubitably to the existence of septic emboli. ”

“ Aortic obstruction is more frequently connected with cerebral embolism than any other valvular lesion.
The left middle cerebral artery is the most common seat of aortic cardiac emboli. The left lower limb is more subject to embolism from aortic valvular disease than the right. The splenic and renal vessels are also the frequent seat of such emboli. Sometimes embolism is due to small auricular or ventricular [p. 657] clots that form behind the obstruction. Such clots have occluded the aortic orifice and caused sudden death.7 ”

“ In the young, apoplectic attacks are usually due to cerebral softening, thrombosis following acute disease or embolism resulting from endocarditis. Between the ages of twenty and forty apoplexies usually mean syphilitic thrombosis. In the later decades of life, either hemorrhage, thrombosis, embolism or softening may occur. ”

“ Embogue, em-bōg′, v.i. to discharge itself.
Emboil, em-boil′, v.i. (Spens.) to burn with anger.—v.t. to cause to burn with anger: to irritate.
Embolden, em-bōld′n, Imbolden, im-, v.t. to make bold or courageous. [Em, to make, and bold.]
Embolism, em′bo-lizm, n. the insertion of days in an account of time to produce regularity: an intercalated prayer for deliverance from evil coming after the Lord's Prayer: (med.) the presence of obstructing clots in the blood-vessels.—adjs. Embolis′mal, Embolis′mic.—n. Em′bolus, the clot of fibrin obstructing a blood-vessel, causing embolism. ”

“ Most of these cases, however, showed rather the effects on the brain and the production of right or left hemiplegia than the asphyxic sequelæ of obstruction of the trunk or divisions of the pulmonary artery. In France the doctrine of embolism was at first received doubtingly, and was the subject of animated discussions at the Medical Society of the Hospitals in 1857. In this year Charcot and Ball published the first case of pulmonary embolism which had been observed in that country. ”

“ The absolute and relative size of cortex and medulla, and the distinctness of the boundary between them, should be noted.
Hemorrhages may occur in any part of the brain, and may be large or small. Rupture into a ventricle is always fatal. The large hemorrhages are due to rupture of a diseased artery; small punctate hemorrhages throughout cortex are usually embolic (fatty embolism) . Old hemorrhages are brownish in color (pigment) . Areas of softening are usually the result of embolism, thrombosis or sclerosis. ”

“ Apoplexy, however, is not always the result of hemorrhage, but occurs with many cases of embolism and of thrombosis, and is sometimes, so far as we can tell, dependent upon neither of these conditions, recovery in one set of cases taking place so rapidly as to preclude the supposition of a considerable organic lesion, and in others, which are fatal, nothing being found beyond an excess of serum or of vascularity, and sometimes not even that. ”

“ A pulmonary embolism is not necessarily fatal, for a woman after a pelvic operation may complain of sudden pain in the chest, urgent dyspnœa, exhibit great mental distress, and in a short time spit up sputum mixed with blood. In a few hours the urgent symptoms subside and in two or three days pass away, and the patient recovers. I have seen five examples of this mild form of pulmonary embolism after hysterectomy. ”

“ Thrombosis—clotting in the vessel. Embolism, blocking of the vessel. Thrombus may form in any bloodvessel. Embolism occurs in arteries. Clot follows the blood current. Causes of clotting—fibrinogen, paraglobulin, fibrine ferment; foreign bodies; parasites; air; blood that has been exposed, transfusion; ærial germs; disease germs; chemical coagulants; high and low temperatures; breaches of endothelium; congestion or inflammation of the serosa; stasis of blood and extension of clot; ligature near a branch vessel: deoxidation and carbonization of blood, marasmus; neoplasms ”

“ Coats3 states that aneurism of the larger arteries is the most frequent source of hemorrhage in persons under fifty. They may be due to embolism, producing, when the occlusion is not complete, mechanical injury to the walls of the vessels by the constant hammering upon them of the embolus under the impulse of the blood. If this etiology is a common one, it accounts for the frequent situation of these aneurisms in the middle cerebral arteries. ”

“ Thrombosis and Embolism.
A blood-clot formed within a blood-vessel during life is called a thrombus. The entire process of which the thrombus is the essential element is designated thrombosis.
These terms were introduced by Virchow17 to avoid the confusion which resulted from regarding the process and result as synonymous with inflammation of the vessel. All writers, even at present, do not adhere to this strictness of meaning. For a thrombus of the vulva indicates a clot of extravasated blood within the connective tissue of the labium ”

“ In air-embolism the pulmonary arteries contain a mixture of blood and air looking like a stiff-beaten white of egg of red color. Large emboli of liver-tissue or liver-cells may be found in the pulmonary arteries after traumatic rupture of the liver. Fat-emboli of the smaller arteries can be recognized by the naked-eye. Thrombosis of both pulmonary arteries and veins is very common in chronic valvular lesions, pneumonia, terminal infections, burns of the skin, poisoning with hemolytic agents, etc. ”

“ Entrance of Air into Veins--Air Embolism.#--This serious, though fortunately rare, accident is apt to occur in the course of operations in the region of the thorax, neck, or axilla, if a large vein is opened and fails to collapse on account of the rigidity of its walls, its incorporation in a dense fascia, or from traction being made upon it. If the wound in a vein is thus held open, the negative pressure during inspiration sucks air into the right side of the heart. This is accompanied by a hissing or gurgling sound, and with the next expiration some frothy blood escapes from the wound. ”

“ Thrombosis is liable to occur when calcareous plates are exposed in the lumen of the vessel by destruction of the endothelium, and this predisposes to embolism. Arterio-sclerosis also interferes with the natural arrest of hæmorrhage, and by rendering the vessels brittle, makes it difficult to secure them by ligature. In advanced cases the accessible arteries—such as the radial, the temporal or the femoral—may be felt as firm, tortuous cords, which are sometimes so hard that they have been aptly compared to “pipe-stems.” ”

“ Embolism, Thrombosis, Hemorrhage, and Abscess of the Spinal Cord.
Although the spinal cord is a segment of the same central organ as the brain, nourished in a similar way, and subject to the same physiological and pathological laws, lesions of the vascular apparatus, which play so important a part in brain pathology, play a comparatively insignificant one in that of the spinal cord. Embolic, thrombic, and primary hemorrhagic lesions of the cord are so rare that their possible existence has even been denied. ”

“ When these symptoms have been remarked, the question has been raised as to whether the patient was suffering from an epileptic seizure.44 The first impressive effects of pulmonary embolism undoubtedly attach themselves to the respiration and circulation. The nervous system is not always so visibly affected. Frequently the patients preserve complete mastery of their intelligence to the end, and cry out in no doubtful accents, "I am stifling! I am dying!" Occasionally they even point with their fingers to the exact seat of the sudden obstruction in the chest. ”

“ Thrombi in the veins produce inflammation in and around the vein, thickening of the skin and connective tissue, gangrene and hemorrhage.
The consequences of embolism vary with the character of the embolus and its situation. A simple plug of fibrine in a vessel only produces changes in the circulation, but a plug from a gangrenous thrombus has a tendency to excite suppurative inflammation wherever it lodges.
The size of the artery thus obstructed, and the character of its collateral circulation also lead to a variety of results. If a large artery is stopped, the part becomes empty ”

“ I had to have some physical exertion to relieve the tension. I felt I might faint or have a stroke unless I moved about. My father had been stricken with an embolism at about my age, and I've read such weaknesses are inherited. ”

“ It occurs in [p. 1174] both high and low walks of life, attacking more frequently men than women.
DIAGNOSIS.—The symptoms of progressive labio-glosso-laryngeal paralysis are so characteristic in themselves as to exclude any mistake in the formation of a diagnosis. There are, nevertheless, some pathological conditions, such as hemorrhages in the medulla oblongata or thrombosis and embolism of the arteries supplying the latter with blood, which may give rise to the same or very similar phenomena, and thus render a correct diagnosis difficult. ”

“ Infarction, causes of blocking; disintegration of clots, softening, liquefaction, ulceration, action of microbes; excess of white globules; air; fat; parasites. Pathogenesis; complete occlusion of vessel; infarction; sequestrum; collateral circulation; embolism of external iliac or femoral artery; effects on pulse; during rest; atrophy; lameness comes on with exertion; disappears under rest; circulation inadequate to sustain active function. Embolism of internal iliac artery; effect on pulse; on tail and pelvic organs. Embolism of axillary artery; effect on pulse, action, nutrition. ”

“ Arterial disease is to be looked upon as of some importance, but cardiac valvular lesions of much greater, and the causes of these, like rheumatism, scarlet fever, and the puerperal condition, are not always to be escaped. The presence of a detachable piece of fibrin in the pulmonary veins, heart, or aorta being granted, nobody can possibly say what will prevent its being loosened and lodging in one of the cerebral arteries; so that, practically, the prophylaxis of embolism consists in the judicious treatment of acute rheumatism and the other conditions just mentioned. ”

“ When Embolism prevails to a considerable extent, the orgasm is a dangerous thing for that man, and death stands close by whenever he forgets that he is no longer a youth. But if such will insist on being foolish, they should first get rid of the Embolism, and cleanse the body of all superfluities in the shape of phosphates, alkaline or acid ”

“ In the thorax the heart is flabby, pale, and small; clots are found in the right and left side extending into the pulmonary artery and aorta. Sudden death has been attributed to cardiac thrombosis. That coagula [p. 706] do form in the heart during life is shown by the sudden occurrence of cerebral embolism with aphasia.32
32 The writer has seen one case of this kind occurring during the effort at stool in a patient who was very feeble and very anæmic from chronic intestinal inflammation with ulceration. ”

“ In the circulatory system symptoms always of threatening and often of fatal import may arise: embolism may occur at various points, particularly in the lungs and spleen, occasioning hemorrhagic infarctions, which have undoubtedly been the occasion of the sudden deaths sometimes observed in scorbutic cases not apparently of a very dangerous form nor attended with an excessive degree of exhaustion. ”

“ Possibly fat embolism should be added to the list of possible causes of the hastening of the neurosyphilitic process. Fat embolism in the brain has been shown by various authors to be accompanied by minute hemorrhages, in the midst of which by proper stains the fat embolism can be made out. ”

“ So far as we can tell, the causes leading to endarteritis or atheroma are essentially the same as those which produce the periarteritis described in connection with cerebral hemorrhage, and we may therefore put down old age, alcohol, and strain as among the causes of cerebral embolism. Injuries of the lungs leading to thrombosis of the veins may be considered as possible sources for the formation of an embolus, and we might suppose that phthisis and pneumonia would furnish plugs which would lodge in the brain, though as a matter of fact they seldom do so. ”