Hypertensive encephalopathy

In Hypertensive encephalopathy condition the priorities are to maintain the airway and to reduce the blood pressure using a parenteral agent such as intravenous sodium nitroprusside or hydralazine.

Fits should be controlled with parenteral diazepam (10 mg i.v.), but this may induce respiratory depression so facilities for resuscitation must be available.

In children, neurologic symptoms may occur with diastolic pressure still in the range of about 100 mmHg (normal upper limit for infant is 60-65 mmHg and for teenager is 80-85 mmHg). Renal disease is frequently present in children with hypertensive encephalopathy.

The definitive diagnosis of this syndrome depends on accurate exclusion of other causes that may be associated with elevated blood pressure and neurologic deficits. Treatment is aimed at preventing or limiting target organ (brain) damage.

Typical findings include arteriolar disease, papilledema, cotton wool patches, hard exudates, and hemorrhage. CSF opening pressure is frequently elevated.

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