Blood pressure > 200/130 mmHg and general brain dysfunction[1]
Differential diagnosis
Uremic encephalopathy, stroke (ischemic or bleeding), hydrocephalus, cocaine toxicity[1][2]
Medication
Labetalol, sodium nitroprusside[2]
Frequency
Uncommon[2]
Hypertensive encephalopathy (HE) is general brain dysfunction due to significantly high blood pressure.[3] Symptoms may include headache, vomiting, trouble with balance, and confusion.[1] Onset is generally sudden.[1] Complications can include seizures, posterior reversible encephalopathy syndrome, and bleeding in the back of the eye.[1][3]
In hypertensive encephalopathy, generally the blood pressure is greater than 200/130 mmHg.[1] Occasionally it can occur at a BP as low as 160/100 mmHg.[4] This can occur in kidney failure, those who rapidly stop blood pressure medication, pheochromocytoma, and people on a monoamine oxidase inhibitor (MAOI) who eat foods with tyramine.[2] When it occurs in pregnancy it is known as eclampsia.[2] The diagnosis requires ruling out other possible causes.[1]
The condition is generally treated with medications to relatively rapidly lower the blood pressure.[2][3] This may be done with labetalol or sodium nitroprusside given by injection into a vein.[2] In those who are pregnant, magnesium sulfate may be used.[2] Other treatments may include anti-seizure medications.[2]
Hypertensive encephalopathy is uncommon.[2] It is believed to occur more often in those without easy access to health care.[2] The term was first used by Oppenheimer and Fishberg in 1928.[5][6] It is classified as a type of hypertensive emergency.[4]
^ abcdefghijGoldman L, Schafer AI (2011). Goldman's Cecil Medicine E-Book. Elsevier Health Sciences. p. 2326. ISBN 978-1437736083. Archived from the original on 2017-10-22.
^ abcdefghijklLynn DJ, Newton HB, Rae-Grant A (2004). The 5-minute Neurology Consult. Lippincott Williams & Wilkins. p. 174. ISBN 9780683307238. Archived from the original on 2017-10-22.
^ abcPrice RS, Kasner SE (2014). "Hypertension and hypertensive encephalopathy". Neurologic Aspects of Systemic Disease Part I. Handbook of Clinical Neurology. Vol. 119. pp. 161–7. doi:10.1016/B978-0-7020-4086-3.00012-6. ISBN 9780702040863. PMID 24365295.
^ abCameron P, Jelinek G, Kelly AM, Brown AF, Little M (2014). Textbook of Adult Emergency Medicine E-Book. Elsevier Health Sciences. p. 274. ISBN 9780702054389. Archived from the original on 2017-10-22.
^Johnson RJ, Feehally J, Floege J (2014). Comprehensive Clinical Nephrology E-Book. Elsevier Health Sciences. p. 439. ISBN 9780323242875. Archived from the original on 2017-10-22.
^Oppenheimer, B. S. (December 1979). "Hypertensive encephalopathy". Archives of Internal Medicine. 2 (6202): 1387–8. doi:10.1001/archinte.1928.00130140126010. PMC 1597139. PMID 519473.
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