Hypertensive Encephalopathy

Oppenheimer, Bernard S.

doi:10.1001/archinte.1928.00130140126010

Cited by 125 publications

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“…Oppenheimer and Fishberg, 3 who were the first to recognize HTE, identified the elevation of pressure as the essential causative factor, thereby separating the syndrome from the neurological consequences of ure mia and other metabolic and toxic conditions with which it had previously been confused. HTE is consid ered to occur less frequently than in previous decades because of improved treatment of such antecedent con ditions as acute nephritis, eclampsia, and malignant hypertension.…”

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confidence: 99%

Hypertensive encephalopathy.

Dinsdale¹

1982

Stroke

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confidence: 99%

Hypertensive encephalopathy.

Dinsdale¹

1982

Stroke

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“…The lack of retinal changes in hypertensive emergencies has been reported previously yet has, to our knowledge, never been quantified. 8,9 A possible explanation for the lack of retinal abnormalities could lie in the scarce sympathetic innervation of arteries supplying the posterior region of the brain, which is predominantly affected in hypertensive encephalopathy, compared with arteries originating from the middle-cerebral artery that supply the retina. 11 The posterior-cerebral artery is subject to a lower damping of BP oscillations compared with flow in the middle-cerebral artery, 12 which may be, therefore, more protected from hyperperfusion at high BP values.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 To assess the frequency of retinal abnormalities consistent with grade III and IV HRP, we conducted a retrospective cohort study of patients admitted with hypertensive encephalopathy in the past 16 years.…”

Section: Introductionmentioning

confidence: 99%

Value of retinal examination in hypertensive encephalopathy

2009

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The presence of grade III or IV hypertensive retinopathy (HRP) is considered to distinguish hypertensive urgencies from emergencies. However, case-reports suggest that these retinal changes may be lacking in patients with hypertensive encephalopathy. To assess the frequency of grade III and IV retinopathy in this hypertensive emergency, we conducted a retrospective cohort study. We retrieved 162 patients with malignant hypertension and 34 patients (17%) fulfilled the predefined criteria for hypertensive encephalopathy. Data on retinal examination were incomplete for 6 patients (18%), thus leaving 28 patients who were analysed for the presence or absence of grade III and IV HRP. In 9 (32%) patients with hypertensive encephalopathy, grade III or IV HRP was absent, 11 (39%) patients presented with grade III and 8 (29%) patients with grade IV retinopathy. Patients without retinal abnormalities were on average 13 years younger (P ¼ 0.05), more often black (P ¼ 0.02) and displayed lower blood pressure (BP) values (P ¼ 0.04 for systolic and diastolic BP). A substantial proportion of patients with hypertensive encephalopathy lack grade III or IV HRP. This suggests that the decision to admit these patients should not only rely on the presence of grade III and IV retinopathy alone, but should also include a careful neurological examination.

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“…A relação causal entre disfunção cerebral transitória, como uma crise convulsiva, e hipertensão arterial foi primeiramente descrita por Oppenheimer e Fishberg, em estudo publicado em 1928 13 . Esses autores observaram que quadro neurológico complexo em um paciente, caso que se relacionava com a evolução de hipertensão arterial grave de causa renal, verificando que os picos hipertensivos do paciente eram acompanhados pelo agravamento do quadro neurológico e por convulsões.…”

Section: Fig 3 Tomografia Computadorizada Cerebral Evolutiva Normal unclassified

Encefalopatia hipertensiva associada a estado de mal epiléptico de repetição: relato de caso

Antoniuk

Bruck

Morais³

et al. 2000

Arq. Neuro-Psiquiatr.

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RESUMO -Criança de cinco anos, feminina, branca, com história de oito internamentos nos últimos dois meses por crises convulsivas caracterizadas por vômitos, perda de consciência e clonias em hemicorpo direito. No exame físico, verificou-se hipertensão arterial grave (270/140 mmHg). Os estudos de neuroimagem (tomografia computadorizada e ressonância magnética) revelaram extensas áreas hipodensas, sugerindo edema cerebral. A arteriografia renal mostrou estenose da artéria renal direita, determinando a etiologia da hipertensão arterial. Com o controle da hipertensão, após a nefrectomia, houve reversão completa dos sintomas, assim como das anomalias de imagem.PALAVRAS-CHAVE: encefalopatia hipertensiva, edema cerebral, estenose da artéria renal. Hypertensive encephalopathy associated to repetitive seizures : case reportABSTRACT-Five years old, female, who started with tonic-clonic seizures on the right side of the body, with vomits and unconsciousness. The patient had been hospitalized for eight times in the last sixty days because of seizures. At physical exam, she had a severe arterial hypertension (270/140mmHg). The computerized tomographic scan and magnetic ressonance imaging revealed hypodense areas, mainly on the right parietal-temporal region, suggesting presence of edema. The angiography showed stenosis of the right renal artery, that was the cause of arterial hypertension. After the control of arterial hypertension by nefrectomy, the patient had a complete remission of the symptoms, as well as the images anomalies.KEY WORDS: hypertensive encephalopathy, brain edema, stenosis of the renal artery.O estado de mal epiléptico de repetição pode estar associado a múltiplas causas. Apresentamos o relato de um caso pediátrico que exemplifica uma situação clínica incomum, na qual se demonstrou que um quadro de repetidas crises convulsivas tinha por causa primária uma encefalopatia hipertensiva subjacente; uma síndrome neurológica que se instala em decorrência da elevação súbita e grave da pressão arterial, levando a alterações de neuroimagem, compatíveis com edema cerebral 1,2 . Essa síndrome caracteriza-se clinicamente por náuseas, vômitos, cefaléia, alteração no nível de consciência, distúrbios visuais, papiledema e convulsões 3 . Dentre as diversas etiologias de hipertensão arterial secundária em crianças, destacam-se as doenças renais (74%), coarctação da aorta (15%), alterações renovasculares (7%), doenças adrenais (1%), enfermidades sistêmicas (1%) e tumores não adrenais (1%) 4 .

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Hypertensive Encephalopathy

Cited by 125 publications

References 0 publications

Hypertensive encephalopathy.

Hypertensive encephalopathy.

Value of retinal examination in hypertensive encephalopathy

Encefalopatia hipertensiva associada a estado de mal epiléptico de repetição: relato de caso

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