From this article you will learn about the rather serious complication of hypertension, which often leads to severe consequences. The subject of our today's article is hypertensive encephalopathy.
Causes of the disease
Hypertensive or hypertensive encephalopathy is one of the complications of hypertension( high blood pressure) characterized by impaired cerebral circulation against high or crash blood pressure levels. This pressure is at 200/100 mm Hg. Art.and above, however, for patients with initially low or low blood pressure, these figures may be lower: from 150/100 to 180/110.
The brain is one of the so-called target organs for hypertension, along with the kidneys, the heart, the retina of the eye. These organs suffer because of high figures of arterial pressure and can irreversibly lose their functions in sufficiently short time. Essentially, hypertensive encephalopathy is the extreme manifestation of a hypertensive crisis with an emphasis on neurological symptoms.
Changes in the brain occur against the background of oxygen starvation of its tissues. High figures of arterial pressure are combined with a pronounced spasm of the blood vessels of the body and a decrease in the supply of tissues, including the brain. The tissues of the nervous system are very sensitive to a lack of oxygen and nutrients, so the symptoms from the central nervous system develop quite brightly and quickly. About the clinical signs of hypertensive encephalopathy, we'll talk just below.
This pathology is one of the most dangerous conditions, which without proper treatment and emergency measures in the next few hours will lead to a stroke - the death of deprived areas of the brain and severe disability. In fact, some textbooks describe hypertensive encephalopathy as a pre-stroke state. The insidiousness of this condition lies in the fact that it develops dramatically and unexpectedly, sometimes against the backdrop of absolute health or sluggish hypertension. They are equally affected by men and women, the peak incidence is at the age of 55-65 years, but there are often episodes of pre-sults in young people aged 35-45 years.
First-aid doctors or district therapists are usually the first to encounter and provide first aid in hypertensive encephalopathy. When making such a diagnosis, the patient should be hospitalized in the specialized neurological or cardiological department, where he will be assisted by the narrow specialists of these units. In special forms of hypertension, nephrologists, vascular surgeons, endocrinologists are involved in the consultation.
With the rapid response of physicians and proper treatment of the patient can be fully restored, but in a number of cases the condition turns into a stroke.
Reasons for
As we have already discussed, the main cause of hypertensive brain lesions is uncontrollably high blood pressure figures. Why do such crises arise?
Uncontrolled and long-term hypertension
Such untreated hypertension is especially hard in people aged 50-60 years, including people with obesity, diabetes, smokers and alcohol users. It is very difficult to tolerate the hypertensive disease of a woman during menopause, when hormonal restructuring against a background of hypertension leads to frequent hypertensive crises. Against such a background, often exacerbation of hypertension turns into a stroke.
Abrupt cancellation or replacement of drugs from increased pressure
Most often, such cancellation is an unauthorized and self-imposed decision of the patient himself, less often drugs are canceled by doctors. Against the background of a sharp abolition of the usual medication, the so-called "cancellation effect" or "Rebound-effect" occurs, in which the symptoms of the disease are dramatically and repeatedly exaggerated. Unsuccessful drug replacement may also lead to a sudden uncontrolled increase in pressure.
Renal Hypertension
Renal or renal hypertension is a special type of hypertensive disease, typical of young patients as well. This is a complex form of hypertension associated with a congenital or acquired abnormality of the renal arteries. The pressure in such patients reaches values above 200/100 mm Hg.and is poorly treated with conventional drugs.
Gestational hypertension - gestosis
Pregnancy and its gravest complication is gestosis. Gestosis is characterized by the main "three symptoms" - high blood pressure, swelling and the appearance of protein in the urine. Sometimes the arterial pressure in gestosis also reaches high figures and leads to the appearance of signs of suffering of the brain.
Hormone-producing tumors
Pheochromocytoma is a tumor from adrenal tissue. This is a very interesting neoplasm, which is both benign and malignant in nature. This tumor, like the adrenal glands itself, produces hormones adrenaline and noradrenaline, however in very large quantities. These hormones cause attacks of aggression, vasospasm, increased heart rate and a significant increase in pressure. This disease, like renal hypertension, is characterized by very high pressure numbers - above 200/120 mm Hg. Art.and almost complete resistance to most medications. Hypertensive encephalopathy often complicates such high levels of pressure. Pheochromocytoma is often found in young patients and is treated only surgically.
Overdose of certain substances
These substances include: heart drugs, caffeine, narcotic substances, alcohol, drugs for doping, especially against the background of existing problems with pressure and blood vessels.
Nervous shocks
Strong stress or emotional shock on the background of similar problems.
Symptoms of
Symptoms of oxygen starvation and a lack of nutrients in the central nervous system are called neurological. Here are the main symptoms of hypertensive encephalopathy:
- Severe headache. The pain can be as spilled, when the patient complains that the whole head "hurts", and can be quite clearly localized.
- "Noise in the head" is a simple, but very clear description of the manifestations of high pressure.
- Nausea and vomiting. These symptoms are specific for many diseases, but their special feature with neurological disorders is that vomiting occurs at the height of the headache and does not bring any relief to the patient.
- Dizziness, impaired coordination and loss of balance, right down to the falls.
- Darkening in eyes, flashing of "flies" before eyes, double vision and other visual impairments. These symptoms also occur at the height of the headache.
- Loss of orientation in time and space, dips in memory. The patient can forget what day is today, where he is and even what his name is.
- Auditory and visual hallucinations, imaginary space curvatures.
- Attacks of panic, aggression, fear of death, motor and emotional overexcitation. The patient wants to run somewhere, hide, defend or panically afraid of dying.
- Convulsions. Convulsive syndrome in pregnant women marks the development of extreme severity of gestosis - eclampsia. If in a few minutes not to give birth to a woman - death for her and the child is inevitable.
All these signs are very similar to those in hypertensive crisis, so only experienced neurologists and cardiologists can understand and see the fine line between the crisis, hypertensive encephalopathy and the already developed stroke.
Diagnostic methods
To clarify the diagnosis, as well as the immediate causes of this sudden surge in pressure, you should carefully examine the patient.
- Measurement of blood pressure on the hands and feet is mandatory, as well as constant monitoring in the dynamics - the profile or daily monitoring of blood pressure.
- Electrocardiogram to exclude severe complications - myocardial infarction and rhythm disturbances.
- Inspection of the neurologist to determine the patient's condition through special neurological tests and tests.
- Survey of the ophthalmologist with an estimation of sight and a status of an eyeground to exclude a hemorrhage in an retina of an eye.
- Blood and urine tests for a wide variety of enzymes and substances - for the search for myocardial infarction, signs of kidney damage, liver, indirect signs of pheochromocytoma, determination of the level of opiates and alcohol.
- Electroencephalogram for the search for pathological brain rhythms and activities.
- MRI or magnetic resonance imaging to find areas of ischemia or oxygen starvation of the brain, as well as its edema.
- Ultrasound examination of the abdominal cavity, heart and brachiocephalic arteries.
This already extensive list of tests for hypertensive encephalopathy may be supplemented by other indications.
Treatment of
The patient must be hospitalized in the intensive care unit for 24 hours monitoring of monitors and personnel. We list the main principles of therapy for hypertensive encephalopathy:
- Slow and gradual decrease in blood pressure - no faster than 20% of the initial figures per hour. Rapid pressure drop can lead to a sharp oxygen starvation of the brain due to insufficient blood supply.
- The use of dehydrating drugs - drugs designed to combat cerebral edema - diuretics and corticosteroids.
- Neuroprotectants are a group of drugs that have a protective effect on the nerve cells of the brain: vitamin preparations, antioxidants, pyracetam, cerebrolysin, emoxipin.
- Sedative or sedative drugs - including antidepressants and antipsychotics to stabilize the patient and relieve psychomotor agitation.
- Anticonvulsants as needed.
Then the patient needs to undergo a rehabilitation course, follow a diet, use vitamin therapy, you can go to a sanatorium. It is very important to choose competent and effective treatment of arterial hypertension or take measures to promptly eliminate its cause - stenosis of the renal arteries or pheochromocytoma.
The patient should carefully monitor his pressure, lead a healthy lifestyle, engage in light sports, maintain a diet and control his weight.
Disease prognosis
Hypertensive encephalopathy is a fine line between high blood pressure and stroke. One can never predict when a particular patient will cross this line.
With proper and rapid treatment, the patient's predictions are not bad - in most cases, stroke can be avoided and all symptoms of hypertensive encephalopathy can be eliminated within 12-48 hours. However, in a number of cases, cerebral circulation disorders become critical, which can lead to severe disability and even death.
