HYPERTENSIVE ENCEPHALOPATHY

DIAH MUSTIKA HW SpS,KIC

INTENSIVE CARE UNIT of EMERGENCY DEPARTMENT
NAVAL HOSPITAL dr RAMELAN, SURABAYA

Introduction
Oppenheimer and Fishberg, 1928
Hypertensive emergency:
Severe elevation of blood pressure that precipitates
end organ damage
Acute pulmonary edema, congestive heart failure, ischemic
chest pain, retinopathy, papilledema, retinal hemorrhage,
aortic dissection, rapid deterioration of renal function,
hypertensive encephalopathy

Hypertensive urgency:
Severe elevation of blood pressure without end organ
involvement

HYPERTENSIVE ENCEPHALOPATHY
Syndrome of severe hypertension in
association with headache, nausea and
vomiting, visual disturbances, convulsion,
confusion, stupor,coma.
Complicate hypertension from any cause (
chronic renal disease, renal artery stenosis,
acute glomerulonephritis, acute toxemia,
pheochromocytoma, Cushing syndrome),
coccaine, drug administration (aminophylline,
phenylephrine)

 HE is marked by characteristic changes on CT scan

and MRI
Hauser and coworkers:
MRI : bilaterally increased T-2 signal intensity in
white matter
CT scan : reduced density (edema)
concentrated in the posterior part of hemispheres
indicate that the change is due to fluid and there
is little or no mass effect. Scattered cortical lesion
occurs in watershed distribution and correspond to
small infarction.

 HE should not be used to refer to chronic

recurrent headaches, dizziness, epileptic,
seizure, TIAs or stroke with often in
association with high blood pressure.

TREATMENT.
Reduction of MAP within minutes, but no
more than 20-25% during the first 1-2h, with
further reduction over the hours to days
(Chobanian et al., 2003):
Treatment of end organ damage
Monitoring (Arterial line)
Intensive care unit

 Antihypertensive agent:

Rapid and predictable onset

Easy to titrate
Patients premorbid BP
Duration of hypertensive emergency
Concomitant medical disease
Extent of neurological involvement (rised ICP)

 Vasodilators
Sodium nitropruside

initial

titrate

0.5-1mcg/kg/min

as needed

Nicardipine

5 mg/h

at 515min

Fenoldopam

0.03 mcg/kg/min

0.05 mcg/kg/min

Nitroglycerin

5 mcg/min

Enalapril

1.25 mg/6h

increments 5 mcg/min

.
Antiepileptic drugs
Benzodiazepines
Phenitoin
Magnesium