Hypertensive Encephalopathy

WHAT IS IT?

Hypertensive encephalopathy refers to the signs/symptoms of cerebral edema caused by a sudden rise in blood pressure.

Amidst all the terminology it is important to remember what hypertensive encephalopathy ACTUALLY is (source).
Amidst all the terminology it is important to remember what hypertensive encephalopathy ACTUALLY is (source).
WHAT CAUSES IT?

Hypertension is the cause of this condition, however the underlying etiology of the hypertension can vary across presentations.

WHY IS IT A PROBLEM?

If this condition is not managed then affected patients might begin to have seizures, and can even become comatose.

WHAT MAKES US SUSPECT IT?

Risk factors

Past history of hypertension

Initial Presentation

Common Chief Complaints:

  • Mental status changes: restlessness and confusion are common.
  • Change in consciousness
  • Headache
  • Nausea/vomiting 

History Of Present Illness

Patients often have an acute exacerbation that causes hypertension. Examples can include:

  • Patients who abruptly stop taking anti-hypertensive medications

Physical Exam Findings

Vital signs will demonstrate hypertension.

Neurological exam:

  • Brisk reflexes may be present in patients with affected upper motor neurons

Funduscopic examination can show papilledema, often with flame hemorrhages (of the retina) present as well.

Papilledema and flame hemorrhages seen in a patient with hypertension (source)
Papilledema and flame hemorrhages seen in a patient with hypertension (source)
CLINICAL WORKUP

 

HOW DO WE RULE OTHER DIAGNOSES OUT?

 

HOW DO WE TREAT IT? 

 

HOW WELL DO THE PATIENTS DO?

 

WAS THERE A WAY TO PREVENT IT? 

 

WHAT ELSE ARE WE WORRIED ABOUT?

Kidney damage can be caused by such severe hypertension.

Aortic dissection is a risk of such sever hypertension.

OTHER HY FACTS?

 

FURTHER READING

DynaMed

UpToDate

 

Page Updated: 07.29.2016