Hypertensive encephalopathy
Hypertensive encephalopathy (HE) is general brain dysfunction due to significantly high blood pressure. Symptoms may include headache, vomiting, trouble with balance, and confusion. Onset is generally sudden. Complications can include seizures, posterior reversible encephalopathy syndrome, and bleeding in the back of the eye.
| Hypertensive encephalopathy | |
|---|---|
| Specialty | Emergency medicine, Cardiology, Neurology |
| Symptoms | Headache, vomiting, trouble with balance, confusion |
| Complications | Seizures, bleeding in the back of the eye |
| Usual onset | Sudden |
| Causes | Kidney failure, rapidly stopping blood pressure medication, pheochromocytoma, taking monoamine oxidase inhibitor with foods containing tyramine, eclampsia |
| Diagnostic method | Blood pressure > 200/130 mmHg and general brain dysfunction |
| Differential diagnosis | Uremic encephalopathy, stroke (ischemic or bleeding), hydrocephalus, cocaine toxicity |
| Medication | Labetalol, sodium nitroprusside |
| Frequency | Uncommon |
In hypertensive encephalopathy, generally the blood pressure is greater than 200/130 mmHg. Occasionally it can occur at a BP as low as 160/100 mmHg. 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. When it occurs in pregnancy it is known as eclampsia. The diagnosis requires ruling out other possible causes.
The condition is generally treated with medications to relatively rapidly lower the blood pressure. This may be done with labetalol or sodium nitroprusside given by injection into a vein. In those who are pregnant, magnesium sulfate may be used. Other treatments may include anti-seizure medications.
Hypertensive encephalopathy is uncommon. It is believed to occur more often in those without easy access to health care. The term was first used by Oppenheimer and Fishberg in 1928. It is classified as a type of hypertensive emergency.