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Encephalopathy, Hypertensive: Differential Diagnoses & Workup
Updated: Nov 17, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
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 |
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References
Bales A. Hypertensive crisis. How to tell if it's an emergency or an urgency. Postgrad Med. May 1 1999;105(5):119-26, 130. [Medline].
Amraoui F, van Montfrans GA, van den Born BJ. Value of retinal examination in hypertensive encephalopathy. J Hum Hypertens. Oct 29 2009;[Medline].
Aggarwal M. Hypertensive crisis: hypertensive emergencies and urgencies. Cardiol Clin. 2006;24:135-46. [Medline].
Biousse V, Newman NJ, Chang GY. Brainstem involvement in hypertensive encephalopathy: clinical and radiological findings. Neurology. Nov 9 2004;63(9):1759-60; author reply 1759-60. [Medline].
Calhoun DA, Oparil S. Treatment of hypertensive crisis. N Engl J Med. Oct 25 1990;323(17):1177-83. [Medline].
Frohlich E.D. Target organ involvement in hypertension: a realistic promise of prevention and reversal. Med Clin North Am. 2004;88:1-9. [Medline].
Guidelines Subcommittee. 1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension. Guidelines Subcommittee. J Hypertens. Feb 1999;17(2):151-83. [Medline].
Healton EB, Brust JC, Feinfeld DA, Thomson GE. Hypertensive encephalopathy and the neurologic manifestations of malignant hypertension. Neurology. Feb 1982;32(2):127-32. [Medline].
Immink RV, van den Born BJ, van Montfrans GA, Koopmans RP, Karemaker JM, van Lieshout JJ. Impaired cerebral autoregulation in patients with malignant hypertension. Circulation. Oct 12 2004;110(15):2241-5. [Medline].
Lip GY, Beevers M, Beevers DG. Complications and survival of 315 patients with malignant-phase hypertension. J Hypertens. Aug 1995;13(8):915-24. [Medline].
Loyke HF. The three phases of blood pressure in stroke. South Med J. Jun 1990;83(6):660-3. [Medline].
Pancioli AM. Hypertension management in neurologic emergencies. Ann Emerg Med. Mar 2008;51(3 Suppl):S24-7. [Medline].
Schilling S, Hartel C, Gehl HB, Sperner J. MRI findings in acute hypertensive encephalopathy. Eur J Neurol. May 2003;10(3):329-30. [Medline].
Smith TM, Nokes SR. Posterior reversible encephalopathy syndrome: an overview. J Ark Med Soc. Dec 2003;100(6):200-2. [Medline].
Strandgaard S, Olesen J, Skinhoj E, Lassen NA. Autoregulation of brain circulation in severe arterial hypertension. Br Med J. Mar 3 1973;1(5852):507-10. [Medline].
Tsou TP, Yen ZS, Fang CC, et al. Hypertensive encephalopathy. J Emerg Med. Jul 2004;27(1):85-6. [Medline].
Tzourio C, Dufouil C, Ducimetiere P, Alperovitch A. Cognitive decline in individuals with high blood pressure: a longitudinal study in the elderly. EVA Study Group. Epidemiology of Vascular Aging. Neurology. Dec 10 1999;53(9):1948-52. [Medline].
Webster J, Petrie JC, Jeffers TA, Lovell HG. Accelerated hypertension--patterns of mortality and clinical factors affecting outcome in treated patients. Q J Med. Aug 1993;86(8):485-93. [Medline].
Further Reading
Keywords
hypertension, encephalopathy, hypertensive encephalopathy, hypertensive crisis, hypertensive emergency, hypertensive urgency, accelerated hypertension, malignant hypertension, arteriolar damage, necrosis, atherosclerosis
Differential Diagnoses & Workup: Encephalopathy, Hypertensive