Diagnosis of Hypertensive Encephelopathy

Q: Hypertensive encephalopathy, by definition, is a diagnosis of exclusion.

A) True

B) False

Answer: A

Hypertensive encephalopathy occurs due to severe and/or sudden rises in Blood Pressure (BP), resulting in cerebral edema. Hypertensive encephalopathy, by definition, is a diagnosis of exclusion. This is a fundamental concept as it requires all other suspected diagnoses to be ruled out first. An increase in BP may be secondary to other underlying pathophysiology, which may require primary attention.

In terms of management, it is not recommended to drop BP drastically in hypertensive encephalopathy. In the first 24 hours, it is not prudent to drop mean (or systolic) BP more than 15 percent. Patient who have chronic hypertension have their cerebral blood flow shifted to the right, and should not attempt to correct acutely, which may result in cerebral herniation. It's a simple graph, but immensely essential to keep the visual always.

#hemodynamics

#neurology

References:

1. Miller JB, Suchdev K, Jayaprakash N, Hrabec D, Sood A, Sharma S, Levy PD. New Developments in Hypertensive Encephalopathy. Curr Hypertens Rep. 2018 Feb 26;20(2):13. doi: 10.1007/s11906-018-0813-y. PMID: 29480370.

2. Balahura AM, Moroi ȘI, Scafa-Udrişte A, Weiss E, Japie C, Bartoş D, Bădilă E. The Management of Hypertensive Emergencies-Is There a "Magical" Prescription for All? J Clin Med. 2022 May 31;11(11):3138. doi: 10.3390/jcm11113138. PMID: 35683521; PMCID: PMC9181665.