Abstract

Dr. Fred Orkin, Intern in Medicine, Jewish Hospital of St. Louis, and Assistant in Medicine, Washington University School of Medicine: A 57-year-old Negro man with known hypertension was hospitalized with a one-week history of severe headache, dizziness, and some difficulty in walking. Three years ago the patient consulted a physician because of headaches. He then had a blood pressure of 184/114 mm Hg, minimal arteriolar narrowing, and arteriovenous nicking. An electrocardiogram was consistent with a diagnosis of anterior subepicardial injury and anterolateral ischemia. The roentgenogram of the chest showed a normalsized heart. The creatinine clearance was 40 and 70 ml per minute, respectively on two occasions. Complete blood cell count, urinalysis, urine culture, catecholamine excretion, and a rapid-sequence intravenous pyelogram revealed no abnormalities. Levels of serum glucose, serum urea nitrogen, uric acid, protein-bound iodine, serum electrolytes, and urinary vanilmandelic acid were within normal limits. On a regimen of methyldopa, 1

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