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Encephalopathy, Hypertensive: Differential Diagnoses & Workup

Author: Ryan C Chang, MD, Consulting Staff, Department of Internal Medicine, Divisions of Pulmonary and Critical Care, Kaiser Permanente San Francisco
Coauthor(s): Irawan Susanto, MD, Director of Pulmonary Consultation and Procedures, Associate Professor, Department of Internal Medicine, Divisions of Pulmonary and Critical Care, University of California at Los Angeles School of Medicine
Contributor Information and Disclosures

Updated: Nov 17, 2009

Differential Diagnoses

Eclampsia
Subarachnoid Hemorrhage
Encephalopathy, Hepatic
Subdural Hematoma
Encephalopathy, Uremic
Head Trauma
Pheochromocytoma

Other Problems to Be Considered

Acute CNS event
Acute thrombotic stroke
Cerebral embolus
CNS mass lesions
Encephalitis
Intracranial hemorrhage
Renal failure

Workup

Laboratory Studies

  • Hypertensive encephalopathy is a diagnosis of exclusion; evaluate other etiologies as indicated clinically in the workup. Evaluation includes determining the extent of hypertensive damage and excluding intracranial processes. Laboratory and radiologic studies should not take the place of a careful history and physical examination, which includes a complete neurological and funduscopic examination.
    • CBC count: Obtain a CBC count to determine whether microangiopathic hemolytic anemia is present.
    • Urinalysis, BUN, and creatinine: With hypertensive nephropathy, an elevated creatinine with hematuria and casts may be present.
    • Cardiac enzymes: Exclude myocardial ischemia with cardiac enzymes.
    • Urine toxicology screen: This study is important in excluding drug-induced hypertensive encephalopathy.

Imaging Studies

  • Consider a head CT scan to evaluate the presence of stroke, hemorrhage, or intracranial masses.
  • Obtain chest radiographs to evaluate for possible complications of hypertensive encephalopathy, including aspiration due to altered mentation. Chest radiographs can also be used to evaluate for other conditions, eg, acute pulmonary edema and aortic dissection.

Other Tests

Perform electrocardiogram to evaluate for the presence of cardiac ischemia.

More on Encephalopathy, Hypertensive

Overview: Encephalopathy, Hypertensive
Differential Diagnoses & Workup: Encephalopathy, Hypertensive
Treatment & Medication: Encephalopathy, Hypertensive
Follow-up: Encephalopathy, Hypertensive
References

References

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Further Reading

Keywords

hypertension, encephalopathy, hypertensive encephalopathy, hypertensive crisis, hypertensive emergency, hypertensive urgency, accelerated hypertension, malignant hypertension, arteriolar damage, necrosis, atherosclerosis

Contributor Information and Disclosures

Author

Ryan C Chang, MD, Consulting Staff, Department of Internal Medicine, Divisions of Pulmonary and Critical Care, Kaiser Permanente San Francisco
Ryan C Chang, MD is a member of the following medical societies: American College of Chest Physicians and American Thoracic Society
Disclosure: Nothing to disclose.

Coauthor(s)

Irawan Susanto, MD, Director of Pulmonary Consultation and Procedures, Associate Professor, Department of Internal Medicine, Divisions of Pulmonary and Critical Care, University of California at Los Angeles School of Medicine
Irawan Susanto, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine
Disclosure: Nothing to disclose.

Medical Editor

Oleh Wasyl Hnatiuk, MD, Program Director, National Capital Consortium, Pulmonary and Critical Care, Walter Reed Army Medical Center; Associate Professor, Department of Medicine, Uniformed Services University of Health Sciences
Oleh Wasyl Hnatiuk, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michael R Pinsky, MD, CM, FCCP, FCCM, Professor of Critical Care Medicine, Bioengineering, Cardiovascular Disease and Anesthesiology, Vice-Chair, Academic Affairs, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center
Michael R Pinsky, MD, CM, FCCP, FCCM is a member of the following medical societies: American College of Chest Physicians, American College of Critical Care Medicine, American Heart Association, American Thoracic Society, Association of University Anesthetists, Shock Society, and Society of Critical Care Medicine
Disclosure: LiDCO Ltd Honoraria Consulting; iNTELOMED Intellectual property rights Board membership; Edwards Lifesciences Honoraria Consulting; Applied Physiology, Ltd Honoraria Consulting; Cheetah Medical Consulting fee Consulting

 
 
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