Acute hypertensive encephalopathy

Description:

Acute hypertensive encephalopathy represents a complication of a heavy chronic arterial hypertension or bystry considerable rise in arterial pressure. Now it meets very seldom that, apparently, is caused by high performance of modern antihypertensives at treatment of an arterial hypertension. Etiology and pathogeny. The disease develops at the malignant course of an arterial hypertension, at cancellation of hypotensive drugs, reception of sympathomimetic means, a disease of kidneys, a pheochromocytoma, Cushing's syndrome, toxicosis of pregnant women, stratification of an aorta, a nodular periarteritis. The disease arises against the background of very high arterial pressure (diastolic arterial pressure higher than 120 mm of mercury.) owing to failure of an autoregulyation of cerebral circulation. It is supposed that failure of an autoregulyation leads to expansion of cerebral arteries, hyper perfusion and wet brain with a prelum of capillaries, delay of an intracerebral blood-groove.

Symptoms of Acute hypertensive encephalopathy:

Usually the disease develops within several hours and is shown by the diffusion moderated or expressed headache, nausea, vomiting, disturbance of consciousness against the background of high arterial pressure (diastolic arterial pressure more than 120 mm hg, is more often than 140 — 150 mm of mercury. above). Visual disturbances in the form of blinking or misting of sight, flickering scotoma, sometimes bright visual hallucinations are often noted. At a part of patients generalized or partial epileptic seizures, perhaps psychomotor excitement develop. Extent of disturbance of consciousness varies from easy confusion to a coma. Focal neurologic symptoms are uncharacteristic, their emergence allows to assume intracerebral bleeding or a heart attack of a brain as a complication during acute hypertensive encephalopathy. The disease can be also complicated by congestive heart failure, a fluid lungs, an acute anury or hemolitic anemia.
The diagnosis is confirmed by identification of wet brain at head KT or MPT, and also detection of hypostasis of optic disks, a retinal apoplexy or the expressed spasm of arterioles of a retina at an oftalmoskopiya.
At coma of the patient it is necessary to exclude other possible causes of infringement of consciousness (a hypoglycemic coma, ChMT, a hematencephalon, SAKY, an acute drunkenness, etc.) which are followed by considerable rise in arterial pressure.
It is not necessary to carry all cases of hypertensive crisis to acute hypertensive encephalopathy — one of frequent diagnoses with which patients go to hospital according to the emergency indications. At a part of such patients substantial increase of arterial pressure (diastolic to 120 mm of mercury. above) it is combined with a headache, nausea, vomiting and other complaints that allows to assume acute hypertensive encephalopathy. However at most of these patients at inspection the ischemic or hemorrhagic strokes which are followed by rise in arterial pressure or the expressed arterial hypertension which is combined with headaches of tension or other diseases of a nervous system come to light (the panic attacks, menyeroformny syndromes, a brain tumor, etc.). The states which are followed at rise in arterial pressure only by deterioration in subjective health and emergence of a headache, nausea and vomiting cannot be carried to acute hypertensive encephalopathy (without wet brain signs by results of KT, MPT of the head or an oftalmoskopiya). They represent complications during an arterial hypertension (essential or symptomatic) and are regarded as medical emergencies in cases of high rise in arterial pressure.

Reasons of Acute hypertensive encephalopathy:

Acute hypertensive encephalopathy represents a complication of a heavy chronic arterial hypertension or bystry considerable rise in arterial pressure. Now it meets very seldom that, apparently, is caused by high performance of modern antihypertensives at treatment of an arterial hypertension. Etiology and pathogeny. The disease develops at the malignant course of an arterial hypertension, at cancellation of hypotensive drugs, reception of sympathomimetic means, a disease of kidneys, a pheochromocytoma, Cushing's syndrome, toxicosis of pregnant women, stratification of an aorta, a nodular periarteritis. The disease arises against the background of very high arterial pressure (diastolic arterial pressure higher than 120 mm
hg) owing to failure of an autoregulyation of cerebral circulation. It is supposed that failure of an autoregulyation leads to expansion of cerebral arteries, hyper perfusion and wet brain with a prelum of capillaries, delay of an intracerebral blood-groove.

Treatment of Acute hypertensive encephalopathy:

The main directions of therapy — normalization of arterial pressure and removal of wet brain. Recommend to reduce average hemodynamic arterial pressure within an hour approximately by 20% of initial level, and in the subsequent 24 h to achieve values, usual for this patient (diastolic arterial pressure usually not lower than 90 mm of mercury.). The initial bystry lowering of arterial pressure can be reached intravenous administration of Sodium nitroprussidum (since a dose of 0,3 — 0,5 mkg/kg in 1 min.) or a labetalola (in a dose of 2 mg/min.) or diazoxide (in a dose of 15 — 30 mg/min.). Further perhaps oral administration of beta adrenoblockers, antagonists of calcium ions, inhibitors of an angiotensin-converting enzyme, diuretics and other hypotensive drugs.