Cholesterol emboli syndrome history and symptoms: Difference between revisions

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{{Cholesterol emboli syndrome}}
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==Overview==
==Overview==
==History and Symptoms==
Clinical presentation is variable and depends on the organ involved by cholesterol crystals. Due to cholesterol embolization, many organs such as skin, kidneys, heart, gastrointestinal tract, nervous system, eyes, and skeletal muscles can be involved.
The symptoms experienced in cholesterol embolism depend largely on the organ involved. Non-specific symptoms often described are [[fever]], [[myalgia|muscle ache]] and [[weight loss#Unintentional weight loss|weight loss]]. Embolism to the legs causes a mottled appearance and purple discoloration of the [[toe]]s, smalls [[infarct]]s and areas of [[gangrene]] due to [[necrosis|tissue death]] that usually appear black, and areas of the skin that assume a marbled pattern known as ''[[Livedoid vasculitis|livedo reticularis]]''.<ref name=Modi/>
==History==
 
*Obtaining the history is the essential for making a diagnosis of [[cholesterol emboli syndrome]]. <ref name="Ozkok2019">{{cite journal|last1=Ozkok|first1=Abdullah|title=<p>Cholesterol-embolization syndrome: current perspectives</p>|journal=Vascular Health and Risk Management|volume=Volume 15|year=2019|pages=209–220|issn=1178-2048|doi=10.2147/VHRM.S175150}}</ref>
Kidney involvement leads to the symptoms of renal failure, which are non-specific but usually cause [[nausea]], reduced [[appetite]] ([[anorexia]]), raised [[blood pressure]] (hypertension), and occasionally the various symptoms of [[electrolyte disturbance]] such as an [[cardiac arrhythmia|irregular heartbeat]]. Some patients report [[hematuria]] (bloody urine) but this may only be detectable on microscopic examination of the urine. Increased amounts of [[protein]] in the urine may cause [[edema]] (swelling) of the skin (a combination of symptoms known as [[nephrotic syndrome]]).<ref name=Modi/>
*A positive history of [[atherosclerosis]] and [[cardiovascular]] interventions such as [[angiography]] is suggestive of [[cholesterol emboli syndrome]]. <ref name="Ozkok2019">{{cite journal|last1=Ozkok|first1=Abdullah|title=<p>Cholesterol-embolization syndrome: current perspectives</p>|journal=Vascular Health and Risk Management|volume=Volume 15|year=2019|pages=209–220|issn=1178-2048|doi=10.2147/VHRM.S175150}}</ref>
 
*Clinical presentation is variable and depends on the organ involved by cholesterol crystals.
If emboli have spread to the [[digestive tract]], reduced appetite, nausea and vomiting may occur, as well as nonspecific [[abdominal pain]], [[gastrointestinal hemorrhage]] (vomiting blood, or [[hematochezia|admixture of blood in the stool]]), and occasionally [[acute pancreatitis]] (inflammation of the [[pancreas]]).<ref name=Modi/>
==Symptoms==
 
*The most common symptoms of [[cholesterol emboli syndrome]] include<ref name="Ozkok2019">{{cite journal|last1=Ozkok|first1=Abdullah|title=<p>Cholesterol-embolization syndrome: current perspectives</p>|journal=Vascular Health and Risk Management|volume=Volume 15|year=2019|pages=209–220|issn=1178-2048|doi=10.2147/VHRM.S175150}}</ref><ref name="Falanga1986">{{cite journal|last1=Falanga|first1=Vincent|title=The Cutaneous Manifestations of Cholesterol Crystal Embolization|journal=Archives of Dermatology|volume=122|issue=10|year=1986|pages=1194|issn=0003-987X|doi=10.1001/archderm.1986.01660220112024}}</ref><ref name="QuinonesSaric2013">{{cite journal|last1=Quinones|first1=Adriana|last2=Saric|first2=Muhamed|title=The Cholesterol Emboli Syndrome in Atherosclerosis|journal=Current Atherosclerosis Reports|volume=15|issue=4|year=2013|issn=1523-3804|doi=10.1007/s11883-013-0315-y}}</ref><ref name="SaricKronzon2011">{{cite journal|last1=Saric|first1=Muhamed|last2=Kronzon|first2=Itzhak|title=Cholesterol embolization syndrome|journal=Current Opinion in Cardiology|volume=26|issue=6|year=2011|pages=472–479|issn=0268-4705|doi=10.1097/HCO.0b013e32834b7fdd}}</ref>
Both the [[central nervous system]] (brain and [[spinal cord]]) and the [[peripheral nervous system]] may be involved. Emboli to the brain may cause [[stroke]]-like episodes, [[headache]] and episodes of loss of vision in one eye (known as [[amaurosis fugax]]).<ref name=Modi/> Emboli to the eye can be seen by [[ophthalmoscopy]] and are known as [[Hollenhorst plaque|plaques of Hollenhorst]].<ref name=Schwarcz>{{cite journal| author=Schwarcz TH, Eton D, Ellenby MI, Stelmack T, McMahon TT, Mulder S, Meyer JP, Eldrup-Jorgensen J, Durham JR, Flanigan DP, ''et al''|title=Hollenhorst plaques: retinal manifestations and the role of carotid endarterectomy| journal=J Vasc Surg. |volume=11|issue=5|pages=635-641|pmid=2335833|month=May}}</ref> Emboli to the spinal cord may cause [[paraparesis]] (decreased power in the legs) or [[cauda equina syndrome]], a group of symptoms due to loss of function of the distal part of the spinal cord - loss of control over the [[bladder]], [[rectum]] and skin sensation around the anus.<ref name=Modi/> If the blood supply to a single nerve is interrupted by an embolus, the result is loss of function in the muscles supplied by that nerve; this phenomenon is called a ''[[mononeuropathy]]''.<ref name=Modi/>
**Non-specific symptoms
***[[Fever]]
***[[loss of appetite]]
***[[Fatigue]]
***[[weight loss]]
***[[muscle ache]]
**Cutaneous
***[[livedo reticularis]]
***[[Blue toe syndrome]]
***[[petechiae]] and [[purpura]]
***[[cyanosis]]
***[[Gangrene]]
**Heart
***[[myocardial infarction]]
**Kidney
***[[acute kidney injury]]
****[[nausea]], [[vomiting]], [[electrolyte]] disturbances
***[[chronic kidney failure]]
***[[end stage renal disease]]
***[[focal segmental glomerulonephritis]]
**Gastrointestinal
***[[abdominal pain]]
***[[nausea]], [[vomiting]]
***[[diarrhea]]
***[[GI bleeding]]
***bowel [[ischemia]]
***[[pancreatitis]]
***[[hepatic]] necrosis
**CNS
***[[headache]]
***[[Dizziness]]
***[[Confusion]]
***[[Stroke]]
***[[Paraparesis]]
***[[Mononeuropathy]]
**Eye
***[[eye]] pain
*** transient loss of vision or [[amaurosis fugax]]
***[[blurry vision]]
**lung
***[[alveolar bleeding]]
**Muscle
***[[myositis]]
***[[Rhabdomyolysis]]


==References==
==References==
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Latest revision as of 23:47, 14 February 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nasrin Nikravangolsefid, MD-MPH [2]

Overview

Clinical presentation is variable and depends on the organ involved by cholesterol crystals. Due to cholesterol embolization, many organs such as skin, kidneys, heart, gastrointestinal tract, nervous system, eyes, and skeletal muscles can be involved.

History

Symptoms

References

  1. ↑ 1.0 1.1 1.2 Ozkok, Abdullah (2019). "

    Cholesterol-embolization syndrome: current perspectives

    ". Vascular Health and Risk Management. Volume 15: 209–220. doi:10.2147/VHRM.S175150. ISSN 1178-2048.
  2. ↑ Falanga, Vincent (1986). "The Cutaneous Manifestations of Cholesterol Crystal Embolization". Archives of Dermatology. 122 (10): 1194. doi:10.1001/archderm.1986.01660220112024. ISSN 0003-987X.
  3. ↑ Quinones, Adriana; Saric, Muhamed (2013). "The Cholesterol Emboli Syndrome in Atherosclerosis". Current Atherosclerosis Reports. 15 (4). doi:10.1007/s11883-013-0315-y. ISSN 1523-3804.
  4. ↑ Saric, Muhamed; Kronzon, Itzhak (2011). "Cholesterol embolization syndrome". Current Opinion in Cardiology. 26 (6): 472–479. doi:10.1097/HCO.0b013e32834b7fdd. ISSN 0268-4705.

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