Serial assessments of middle cerebral artery flow velocity with transcranial Doppler sonography in the recovery stage of eclampsia. A case report

Hypertensive Encephalopathy: Clinical and Neuroradiological Findings

Hypertensive encephalopathy is a syndrome consisting of headache, seizures, visual changes, and other neurologic disturbances in patients with elevated systemic blood pressure. The purpose of this study was to analyse the clinical and neuroradiological findings in nine patients with hypertensive encephalopathy, observed in five years.

CT (n = 13), and MR (n = 12), examinations performed in these patients before and after resolution of symptoms were reviewed. Six had the preeclampsia-eclampsia syndrome, and three had hypertensive encephalopathy due to other causes. CT and MR findings in all patients having these examinations were indicative of oedema in the cortex and subcortical white matter in the occipital lobes. Two of the nine patients also had similar findings in the cerebellum and frontal lobes.

The findings on the CT and MR studies resolved on follow-up examinations performed after the hypertension was corrected.

Our results suggest that the radiological findings associated with hypertensive encephalopathy in the appropriate clinical setting are very useful to achieve an early diagnosis.

Hyperperfusion syndromes: insight into the pathophysiology and treatment of hypertensive encephalopathy

Hypertensive encephalopathy is one of the manifestations of a hypertensive crisis. It is not the absolute value of the blood pressure that causes the encephalopathy, rather the presence of an abrupt rise in pressure. In terms of clinical and radiographic findings, there are many similarities among a group of entities, including hypertensive encephalopathy, eclampsia, and immunosuppressant neurotoxicity. Hyperperfusion syndromes may represent these clinical disease states that may share the same pathophysiology. Magnetic resonance imaging fluid attenuated inversion recovery sequences have recognized the prominent cortical involvement of the disease that had been previously missed on computed tomography. Studies have found cortical involvement in 94% of their patients, particularly in mild cases. Animal models demonstrate endothelial damage and enhanced pinocytosis in the cortex as reasons why edema may begin in that region of the brain. Patients diagnosed with hypertensive encephalopathy should be diagnosed and treated promptly in order to avoid further neurological complications. The mean arterial pressure should be lowered by 20% to 25% within the first hour of patient presentation, followed by further gradual reduction in blood pressure over the following 24 hours. Hypertensive emergency in acute ischemic stroke should be managed with more caution. According to the 2003 American Stroke Association treatment guidelines, for patients with ischemic stroke not eligible for thrombolytic therapy, target blood pressures are a diastolic blood pressure <120 mmHg and systolic blood pressure <220 mmHg. The systolic pressure must be <185 mmHg and diastolic pressure <110 mmHg at all times if eligible for thrombolytic therapy.