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Hypertensive encephalopathy is one of the most dangerous possible complications of hypertension, which is associated with damage to the central nervous system due to extremely high blood pressure. Overall, hypertensive encephalopathy is a completely reversible problem, but treatment must be started promptly. So what symptoms suggest this condition and what causes could be hypertensive encephalopathy?

Hypertensive encephalopathy(hypertensive encephalopathy) is a disease that actually began in 1928, when two scientists - Oppenheimer and Fishberg - used this term to describe the condition of a patient who develops acute nephritis associated with neurological symptoms and extremely high blood pressure.

Hypertensive encephalopathy is now happily not a common condition - its prevalence is so low that it is difficult to even find specific statistics about it. It is noticeable, however, that this problem is mainly encountered in young adults and the elderly.

Hypertensive encephalopathy: causes

As you can easily guess, the cause of hypertensive encephalopathy is excessive blood pressure. It's not, however, that every person struggling with hypertension will sooner or later experience this type of encephalopathy.

The greatest risk of this problem is experienced by patients suffering from malignant arterial hypertension - it turns out that among all such patients, from 0.5 to 15% of them develop hypertensive encephalopathy.

Generally speaking, hypertension encephalopathy occurs primarily when a person experiences a sudden increase in blood pressure.

It should be mentioned here that the human nervous system is somewhat prepared for fluctuations in blood pressure - it is equipped with autoregulatory mechanisms, whose task is to maintain the cerebral blood flow at a relatively constant level.

However, when the mean arterial pressure value exceeds a certain valuevalue - 170 mmHg to be precise - self-regulation mechanisms are no longer effective and hypertensive encephalopathy may develop. Associated with it is, among others swelling of the brain of vascular origin, which may result in hypoxia of nerve cells, but also the occurrence of various toxic reactions to neurons.

Hypertensive encephalopathy is not a result of long-term hypertension, but it is caused by a sudden increase in blood pressure.

It is mentioned that this disease usually only occurs when blood pressure values ​​exceed 200/130 mmHg.

The problems that may contribute to this phenomenon are:

  • pheochromocytoma
    • pheochromocytoma
  • consumption of products containing tyramine by people who simultaneously use drugs from the group of monoamine oxidase inhibitors (MAO inhibitors)
  • taking substances that strongly stimulate the activity of the sympathetic nervous system (such as cocaine, LSD or phencyclidine)
  • pre-eclampsia and eclampsia
  • acute glomerulonephritis
  • sudden discontinuation of antihypertensive drugs by people who have been taking such drugs for a long time

Hypertensive encephalopathy: symptoms

Symptoms of hypertensive encephalopathy usually appear in patients one to two days after the onset of a sudden rise in blood pressure. The first ailment in this case is typically a headache (usually described as a dull pain), besides it, patients may also have:

  • feeling very weak
  • mood swings (from apathy to extreme irritability)
  • disturbance of consciousness (which may take the form of a blurry consciousness, but also confusion, stupor or even coma)
  • visual disturbances (e.g. in the form of foggy vision, half-vision, double vision)
  • vomiting
  • seizures
  • hemiplegia
  • aphasia

Hypertensive encephalopathy: diagnosis

In fact, the diagnosis of hypertensive encephalopathy is a diagnosis of exclusion - only after other possible causes of symptoms are eliminated in the diagnostic process, it is possible to diagnose nervous system disorders resulting from excessive blood pressure values.

In the differential diagnosis of hypertensive encephalopathy, units such as :

are taken into account
  • stroke
  • inflammationbrain
  • intracranial bleeding
  • cerebral hematoma
  • head injury
  • encephalopathies of other etiology (e.g. uremic encephalopathy)

In order to exclude the above-mentioned, as well as other units, the symptoms of which may be similar to those of hypertensive encephalopathy, patients are subjected to a whole series of tests, including laboratory tests (e.g. determination of the levels of inflammatory markers - they can exclude possible encephalitis) or imaging tests (thanks to such tests as computed tomography or magnetic resonance imaging, it is possible to eliminate the potential causes of symptoms, e.g. stroke or intracranial bleeding, from the list of potential causes of symptoms in the diagnostic process).

It is only after other possible causes of the patient's ailments have been ruled out, and he or she has significantly increased blood pressure, that it is possible to diagnose hypertensive encephalopathy.

Hypertensive encephalopathy: treatment

In the treatment of hypertensive encephalopathy, the most important thing is to normalize the blood pressure of the patient. For this purpose, other means than in the case of chronic pharmacotherapy of arterial hypertension are used - among the examples of drugs that are used in conditions requiring a sudden reduction of blood pressure, the following can be mentioned:

  • labetalol
  • sodium nitroprusside
  • fenoldopam
  • nitroglycerin

It would seem that in patients with hypertensive encephalopathy, blood pressure should be normalized as soon as possible, but in general it is not the case - lowering blood pressure too quickly could result in a reduction in cardiac output or further disturbances in the autoregulation of blood flow in the brain, and these problems, in turn, could lead to insufficient blood and oxygen supply to the nervous tissue and worsen ischemia.

Due to this risk, it is suggested that in the first phase of treatment of hypertensive encephalopathy, the decrease in blood pressure should not exceed 20-25% of the baseline value.

Hypertensive encephalopathy: prognosis

Hypertensive encephalopathy can be fatal, but it can be prevented by appropriate treatment promptly. Overall, the prognosis of patients with this unit is good - with the early initiation of therapy, most patients fully recover and no neurological deficits remain after recovery.

Hypertensive encephalopathy: prevention

In the prevention of encephalopathyIn hypertensive patients, the most important thing is to lead a generally understood he althy lifestyle. It is advisable to maintain a he althy body weight, use a balanced diet rich in fruits and vegetables, or exercise regularly.

You can also reduce the risk of this disease by giving up smoking or reducing alcohol consumption. All of the above-mentioned effects reduce the risk of developing arterial hypertension, and this disease (especially if left untreated) is most often directly related to hypertensive encephalopathy.

As for those people who have already been diagnosed with hypertension, they can also try to reduce the risk of developing this form of encephalopathy. It is important for them to lead a he althy lifestyle, but also to follow the recommendations regarding the pharmacotherapy of hypertension.

The medications recommended by doctors should be taken regularly and never discontinued them abruptly, on your own, without consulting a specialist - after all, the sudden discontinuation of antihypertensive drugs is one of the factors that can cause hypertensive encephalopathy.

About the authorBow. Tomasz NęckiA graduate of medicine at the Medical University of Poznań. An admirer of the Polish sea (most willingly strolling along its shores with headphones in his ears), cats and books. In working with patients, he focuses on always listening to them and spending as much time as they need.

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Category:

Neurology