CASE HISTORY

Scarlet fever at 3 years old and a bilateral mastoidectomy at 22 years. Neither of these illnesses have a history of oedema or haematuria following infection. 1955: blood pressure taken - only slightly raised. Urine tested and no abnormality found, chest x-ray also normal. First symptoms were increasing frontal morning headaches and then sometimes vomiting. Two months later thirst, nocturia, weight loss, and increasing dyspnoea were added.  Rather a young man when he developed apparently malignant hypertension. June 1959 he went to Llanelly Hospital, where the diagnosis of malignant hypertension was made and treatment was started with pempidine, "apresoline" (hydrallazine hydrochloride) and digoxin. August 1959 he was sent to Hammersmith Hospital. Decline was very rapid - dead within a year from first diagnosis.

PATHOLOGY

Malignant essential hypertension. Medionecrosis of the ascending aorta with dissection of the aorta down to the bifurcation, involving vessels arising from the aorta and upper left renal artery (renal infarction). Surgical repair of the thoracic aorta. Acute tubular necrosis. External aortic rupture into the left pleural cavity.