Clinical characteristics of hypertensive encephalopathy in pediatric patients

Abstract

PurposeThe aim of this study was to assess the clinical characteristics of hypertensive encephalopathy according to the underlying etiologies in children.MethodsWe retrospectively evaluated 33 pediatric patients who were diagnosed as having hypertensive encephalopathy in Chonbuk National University Children's Hospital. Among the patients, 18 were excluded because of incomplete data or because brain magnetic resonance imaging (MRI) was not performed. Finally, 17 patients were enrolled and divided into a renal-origin hypertension group and a non-renal-origin hypertension group according to the underlying cause. We compared the clinical features and brain MRI findings between the 2 groups.ResultsThe renal group included renal artery stenosis (4), acute poststreptococcal glomerulonephritis (2), lupus nephritis (2), and acute renal failure (1); the nonrenal group included essential hypertension (4), pheochromocytoma (2), thyrotoxicosis (1), and acute promyelocytic leukemia (1). The mean systolic blood pressure of the renal group (172.5±36.9 mmHg) was higher than that of the nonrenal group (137.1±11.1 mmHg, P<0.05). Seizure was the most common neurologic symptom, especially in the renal group (P<0.05). Posterior reversible encephalopathy syndrome (PRES), which is the most typical finding of hypertensive encephalopathy, was found predominantly in the renal group as compared with the nonrenal group (66.6% vs. 12.5%, P<0.05).ConclusionWe conclude that the patients with renal-origin hypertension had a more severe clinical course than those with non-renal-origin hypertension. Furthermore, the renal-origin group was highly associated with PRES on brain MRI.

Clinical Characteristics and Factors Associated With Hypertension in 205 Hospitalized Children: A Single-Center Study in Southwest China

“…Hypertensive encephalopathy is a result of cerebral hyperperfusion or an exceeded upper limit of autoregulation by cerebral vessels, which results in cerebral edema and petechial hemorrhages (35). A previous study demonstrated that hypertensive encephalopathy was more common in pediatric patients with renal disorders (34). Similarly, in the present study, there were 41 subjects diagnosed with hypertensive encephalopathy, among which renal diseases accounted for 82.9% of cases.…”

“…Hypertensive encephalopathy manifests as an acute brain dysfunction (disturbance of consciousness, severe headache, convulsions, and visual impairment) induced by an acute and severe increase in BP, which may be one of the earliest symptoms of hypertension in children (34). Hypertensive encephalopathy is a result of cerebral hyperperfusion or an exceeded upper limit of autoregulation by cerebral vessels, which results in cerebral edema and petechial hemorrhages (35).…”

Focal Seizures and Posterior Reversible Encephalopathy Syndrome as Presenting Signs of IgA Vasculitis/Henoch-Schoenlein Purpura—An Educative Case and Systematic Review of the Literature

“…Hypertensive encephalopathy is most commonly encountered in young and middle-aged patients with uncontrolled hypertension. The mean systolic blood pressure reported in pediatric HE patients ranges from 175 mmHg in renal-origin hypertension to 137 mmHg in non-renal-hypertension ( 51 ). HE is a clinical condition caused by elevated blood pressure and which can, per definition, be reversed by blood pressure reduction.…”

Intestinal duplication revealed by posterior reversible encephalopathy syndrome

“…It can be of renal or extrarenal origin. Ahn et al 4) evaluated 33 pediatric patients who were diagnosed as having hypertensive encephalopathy. It appeared that renal artery stenosis was the first responsible etiology of renal origin hypertension.…”