Hypertensive encephalopathy

Hypertensive encephalopathy is a neurological dysfunction induced by malignant hypertension. The term "hypertensive encephalopathy" was introduced to describe this type of encephalopathy by Oppenheimer and Fishberg in 1928. It describes cerebral conditions, typically reversible, caused by sudden and sustained severe elevation of blood pressure. Hypertensive encephalopathy occurs in eclampsia, acute nephritis and crises in essential hypertension. Symptoms of hypertensive encephalopathy include headache, restlessness, nausea, disturbances of consciousness, seizures, bleeding in the retina, and papilledema. Focal brain lesions may be associated with specific neurological symptoms. These neurological impairments may culminate in a coma. The condition is treated by drugs that decrease blood pressure.

Hypertensive encephalopathy is most commonly encountered in young and middle-aged people who suffer from hypertension. Overall, the condition is rare even among hypertensive patients. Different clinicians reported that from 0.5 to 15% of patients with malignant hypertension developed hypertensive encephalopathy. With the development of methods for detection and treatment of hypertension, hypertensive encephalopathy has been becoming more rare.

Symptoms of hypertensive encephalopathy typically start to occur 12–48 hours after a sudden and sustained increase in blood pressure. The first manifestation of these symptoms is a severe headache. Headache occurs in greater than 75% of patients. The patient becomes restless. Alterations in consciousness may follow several hours later, which include impaired judgement and memory, confusion, somnolence and stupor. If the condition is not treated, these neurological symptoms may worsen and ultimately turn into a coma. Other symptoms may include increased irritability, vomiting, diplopia, seizures, twitching and myoclonus of the limbs. Alterations in vision (vision blurring, hemivisual field defects, color blindness, cortical blindness) are common. They occur in 4 out of 11 cases (Jellinek et al. 1964). Hemiparesis, intracerebral hemorrhage, aphasia may also occur, but they are less common.

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