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October 1936

PSYCHIATRIC, NEUROLOGIC AND NEUROPATHOLOGIC STUDIES IN DISSEMINATED ALTERATIVE ARTERIOLITIS

Author Affiliations

NEW YORK

From the Psychiatric Division and the Department of Pathology of the Bellevue Hospital and the New York University College of Medicine.

Arch NeurPsych. 1936;36(4):790-815. doi:10.1001/archneurpsyc.1936.02260100117004
Abstract

Disseminated alterative arteriolitis is a disease entity which may be best understood by an analysis of the literature which led to the concept of acute bacterial endocarditis and what is known in the United States as Libman-Sacks' disease, or verrucous endocarditis without bacteremia. The two cases to be discussed are of interest because of the cerebral symptomatology and the presence of the typical vascular lesions in the brain as well as in other organs of the body, although endocarditis was not present in either case.

In acute bacterial endocarditis the endothelial lining of the heart responds with proliferative changes on the wall and especially on the valves; verrucous masses are formed by the acquisition of thrombotic material consisting of fibrin, blood platelets and leukocytes of the blood stream, and the underlying inflammatory processes are secondary. In the subacute process of Libman-Sacks' disease bacteremia cannot be proved, and the inflammatory reaction

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