Hypertensive encephalopathy -department of neurology-medicine-healthfrom.com que es anoxia

• introduction

• etiology

• prevention

• complication

• symptom

• examine

• diagnosis

• treatment

• basic nursing


Introduction to hypertensive encephalopathy

The disease found in patients with hypertension, due to sudden increase in the arteries is too sudden, leading to cerebral arterial spasm or cerebrovascular regulation function out of control, resulting in severe brain edema of acute cerebrovascular disease. Any type of hypertension as long as the blood pressure was significantly increased, can cause hypertensive encephalopathy, but clinically more common in the past normal blood pressure and sudden onset of hypertension, such as acute glomerulonephritis, pregnancy poisoning, also occur in the radical or severe slowness of hypertension with obvious cerebral arteriosclerosis in patients.Que es anoxia

in addition to sudden increase in blood pressure, often accompanied by severe headache and changes in consciousness, and sometimes there are physical disorders, fundus examination has limited or diffuse retinal arteriolar spasm, but not necessarily bleeding, oozing or edema, antihypertensive treatment can be quickly restored. Basic knowledge

Health insurance disease: yes

Sickness ratio: 0.02% -0.05%

Susceptible people: more common in the elderly

Infection: no infectious

Complications: cerebral hernia cerebral thrombosis cerebral hemorrhage cerebral hernia hypertensive encephalopathy treatment of common sense

Department of internal medicine: department of neurology

Treatment: drug treatment rehabilitation

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Treatment cycle: 45 days

Cure rate: 80%

Commonly used drugs: to save the heart of the capsule nepal to flat tablets


Blood pressure pay attention to low-salt low-fat diet, to avoid emotional constipation and other risk factors, so as to avoid cerebral infarction, myocardial infarction.


Causes of hypertensive encephalopathy

Essential hypertension (25%):

The incidence of essential hypertension accounted for about 1%, a longer history of hypertension, there are obvious cases of cerebral cirrhosis are more prone to normal blood pressure and sudden onset of hypertension, such as: acute high blood pressure and acute glomerular nephritis patients can also occur. Secondary hypertension (20%):

Such as pregnancy-induced hypertension, glomerular nephritis, renal artery stenosis, pheochromocytoma and other moderate increase in blood pressure, but also the possibility of hypertensive encephalopathy.Que es anoxia some drugs or foods induce hypertensive encephalopathy (20%):

Rare cases, the use of monoamine oxidase inhibitors in patients with hypertension, while taking rauwolfia, methyldopa or postganglionic sympathetic nerve inhibitors, can also cause symptoms similar to hypertensive encephalopathy, eating amido-rich food can also induce hypertensive encephalopathy. After carotid endarterectomy (20%):

Patients with high degree of carotid artery stenosis after carotid artery intimal stripping, brain perfusion suddenly increased, can also cause hypertensive encephalopathy.

(B) the pathogenesis

The pathogenesis of hypertensive encephalopathy has not yet fully elucidated, there are two doctrines:

1, excessive regulation or small arterial spasm theory: under normal circumstances, cerebral blood vessels with blood pressure and systolic and blood pressure, blood pressure increases, cerebral vasoconstriction; blood pressure decline when the cerebrovascular expansion, when the sharp increase in blood pressure can cause meninges and deep arterial spasm of the brain, resulting in reduced blood flow into the capillaries, resulting in increased ischemia and capillary permeability, increased blood extravasation in the blood, leading to increased brain edema and intracranial pressure, which can occur on this basis necrotizing small arteritis, spotted bleeding or multiple small embolization, causing acute cerebral blood circulation and brain damage, resulting in a series of clinical manifestations.Que es anoxia

2, automatic regulation of rupture theory: cerebrovascular usually with blood pressure changes in the expansion or contraction, in order to maintain the relative stability of cerebral blood flow, direct measurement of meningeal blood vessel diameter and indirect measurement of cerebral blood flow with isotopes, indicating that blood pressure decreased meningeal blood vessels (MAP) in the 60 ~ 120mmhg between the cerebral blood flow is constant, blood pressure increased significantly, such as MAP 180mmhg, the automatic adjustment mechanism damage, the original contraction of the original blood pressure cerebral blood vessels (blood pressure increased contraction) can not withstand excessive pressure and sudden expansion, resulting in the so-called passive expansion phenomenon, the results of cerebral vascular perfusion, increased cerebral blood flow, increased plasma osmolality, infiltration of blood vessels around the brain edema and intracranial hypertension, resulting in a series of clinical manifestations.Que es anoxia

The main pathological changes in this disease is diffuse brain edema, brain weight can increase more than normal 20% to 30% of the brain, pale brain, brain back flat, shallow tibia, lower ventricle, superficial cerebral artery, capillary vascular and venous dilatation, virchow-robin luminal expansion, brain segment was white, may have petechiae bleeding or small and narrow fissure-like bleeding and lacunar lesions, cerebellar arterial wall vitreous degeneration of vascular endothelial thickening , epicardial hyperplasia, vascular stenosis or obstruction, leading to fibrinous thrombosis and parenchymal infiltration, the formation of the disease-specific small arteries (arteriolopathy), vascular wall cellulose-like necrosis can be ruptured, the majority of petechia or brain internal bleeding, feigin and prose (1959) describe two types of cerebral arterial hyaline degeneration, one for fibrinoid arteritis, visible vascular wall inflammatory changes, blood extravasation, micro-aneurysm formation; another vascular wall no inflammation sexual changes, collagen dyed material to vascular stenosis, small thrombosis and cerebral ischemia, increased intracranial pressure or increased retinal arterial pressure to prevent venous return, can lead to retinal artery cellulose death, infarction or hemorrhage and permanent loss of vision, but also visible swelling oligodendrocytes, dendritic cell disruption (clasmato-dendrosis) and ischemic changes in neural element.Que es anoxia


Hypertensive encephalopathy symptoms common symptoms hypertensive coma breath dyspnea increased intracranial pressure neck strength deficiency disorder inability to lose consciousness

Rapid onset, the disease developed very quickly. Renal impairment is more susceptible to disease.

First, the arterial pressure: the original high blood pressure, before the onset, again increased, diastolic blood pressure above 16kpa, the average arterial pressure often between 20.0 ~ 26.7kpa.

Second, increased intracranial pressure: caused by brain edema. Patients with severe headache, jet vomiting, optic disc edema, retinal artery spasm and flame-like bleeding and arterial spasm and villous exudate.

Third, the disturbance of consciousness: can be expressed as lethargy and coma, mental disorders have occurred.Que es anoxia

Fourth, seizures: can be systemic limitations of seizures, and some epilepsy continuous state.

5, paroxysmal dyspnea: due to respiratory central vasospasm, ischemia and acidosis caused.

Six other symptoms of brain dysfunction: such as aphasia, hemiplegia and so on.

Laboratory tests can be seen increased cerebrospinal fluid pressure (diagnosis has been clear forbidden), cell and protein content can also be increased.


Hypertensive encephalopathy examination started

Laboratory check

1, unless associated with kidney disease or uremia, urine usually no protein, red blood cells, white blood cells and tube, blood urea nitrogen normal.

2, CSF pressure increased, even normal, normal cell count, a very small number of patients with a small amount of red blood cells, protein slightly increased.Que es anoxia

Film degree exam

The imaging of the skull is of great importance to the diagnosis.

1, brain CT: localized or extensive low-density stove brain edema, mainly involving the subcortical white matter, occasionally involving the cortex, schwartz found in hypertensive complicated with hypertensive encephalopathy, cerebral edema is often bilateral, the main located in the occipital lobe, there are located in the parietal lobe, posterior frontal lobe, cerebellar corpus callosum band structure, carotid endarterectomy after hypertensive encephalopathy, cerebral edema in the same side of the operation of the anterior cerebral artery, middle artery blood supply area, blood pressure encephalopathy remission, CT abnormalities disappeared.Que es anoxia

2, brain MRI: similar to the CT changes, MRI on T1 decreased, T2 increased.

3, SPECT: in the CT or MRI showed abnormal parts, showing increased blood perfusion.

4, fundus examination: retinal artery was diffuse or limited strong spasm, sclerosis or bleeding, exudation and optic disc edema.

5, EEG: there are limitations of abnormal or bilateral synchronous sharp slow wave, sometimes the performance of poor rhythm.


Diagnosis of hypertensive encephalopathy

According to the sudden onset of blood pressure and intracranial pressure in patients with high blood pressure symptoms, diagnosis is not difficult, with other acute cerebrovascular disease identification.

(1) lumbar puncture cerebrospinal fluid can be determined to determine the blood.Que es anoxia

(2) subarachnoid hemorrhage: the same as hypertensive encephalopathy, but also may have sudden severe headache vomiting meningeal irritation symptoms, some patients may also have increased blood pressure disorders are usually lighter, rarely hemiplegia, and cerebrospinal fluid was uniform bloody and other characteristics, can be identified with hypertension.

(3) intracranial space-occupying lesions: although there are serious headaches, but for the slow onset, non-sudden, other symptoms of intracranial hypertension and focal neurological signs is also increased blood pressure can be increased, but not high A significant increase in blood pressure encephalopathy.

(4) such as clinical suspected intracranial tumors, can be through brain ultrasound, cerebral angiography or CT and other tests to be diagnosed.Que es anoxia


Treatment of hypertensive encephalopathy

Department of internal medicine: department of neurology

Treatment: drug treatment rehabilitation

Treatment cycle: 45 days

Cure rate: 80%

Commonly used drugs: to save the heart of the capsule nepal to flat tablets

Medical treatement:

The disease in a timely manner to deal with a good prognosis, improper handling can lead to death, so should strive to early diagnosis, bed rest, as soon as possible to lower blood pressure, reduce intracranial pressure and reduce brain edema, control seizures, prevention of heart failure. Specific treatment and treatment measures are:

1, high blood pressure encephalopathy should be in a few minutes to 1h within the diastolic blood pressure quickly reduced to 110mmhg (hypertensive patients) or 80mmhg below (normal blood pressure), to restore the mechanism of cerebrovascular automatic regulation, but not too fast low, in order to prevent cerebral blood flow insufficiency, induced cerebral infarction; the elderly individual differences, blood pressure fluctuations, medication should start from a small amount, and gradually increase the amount, so as not to drop blood pressure too fast, too low, causing myocardial infarction and other bad as a result of.Que es anoxia clinical commonly used:

(1) sodium nitroprusside (sodium nitroprusside): can also make small arteries, capillaries and small venous dilatation, venous return to reduce the amount of blood, left and right ventricular load are reduced, suitable for patients with left heart failure or acute coronary insufficiency , 50mg add 5% glucose solution 500ml intravenous infusion, drip rate 1ml / min, every 2 ~ 3min measured blood pressure, adjust the drip rate and the amount of blood pressure to maintain the appropriate level; this drug buck quickly and steadily, no adverse reactions, but the physical and chemical properties of instability, the preparation must be used within 12h.

(2) nitroglycerin (glyceryl trinitrate): 25mg plus 5% glucose 500ml intravenous infusion, according to blood pressure regulation drip rate, rapid antihypertensive effect, monitoring than sodium nitroprusside simple, less side effects, it was advocated with it instead of nitrop sodium, especially suitable for coronary heart disease, myocardial insufficiency and heart failure.Que es anoxia

(3) reserpine (reserpine) (reserpine): depletion of sympathetic nerve catecholamine storage, dilation of blood vessels and reduce vascular resistance. 1mg intramuscular injection, 1.5 ~ 3h onset, if necessary, every 6 ~ 12h can be repeated injection, suitable for rapid blood pressure after maintenance medication. Side effects of nasal congestion, dry mouth, bradycardia, lethargy and parkinson’s disease-like performance.

(4) captopil (captopil): the main role in the renin – angiotensin – aldosterone system (RAA system) specific competitive inhibitors, inhibition of RAA system angiotensin converting enzyme (ACE), to prevent vascular tension su-I conversion to angiotensin- inhibition of aldosterone secretion, reduce water and sodium retention. 12.5 ~ 25mg orally, 3 times / d, 60 ~ 90min markedly.Que es anoxia visible gastrointestinal reactions, insomnia, dry mouth and neutropenia, heart failure patients should not be used.

(5) can be used after antihypertensive nifedipine (nifedipine, nifedipine) 10 ~ 20mg sublingual or bite swallowing or rectal administration, 3 times / d, can also be used aerosol spray into the oropharynx, each 0.5mg, once every 6 times; the drug calcium channel antagonist, 20 ~ 30min onset, 1.5 ~ 2h blood pressure significantly, 1 times after the efficacy of 80%, can reduce the average arterial pressure by 25%. Of hypertensive encephalopathy with coronary heart disease, the condition is not very serious in patients with the most ideal, is a safer, rapid antihypertensive drugs.

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2, reduce intracranial pressure and reduce brain edema available 20% mannitol 250ml rapid intravenous infusion, every 6 to 8 hours 1, heart and kidney dysfunction with caution; can be intravenous injection with furosemide 40mg, 10% human serum albumin 50ml intravenous infusion or dexamethasone 10 ~ 20mg intravenous combination.

3, epilepsy frequent seizures or status epilepsy preferred stability 10 ~ 20mg slow intravenous injection. If you can not control the stability of 40 ~ 50mg can be added to 10% glucose solution 500ml intravenous infusion, should pay attention to breathing. Can also be used phenytoin (phenytoin sodium), often used in conjunction with stability as a maintenance medication or for the emergence of respiratory depression, the first dose of 500mg added 5% glucose 500ml, intravenous infusion, 300 ~ 500mg / d to maintain efficacy.Que es anoxia followed by adult phenobarbital 0.2g intramuscular injection, and 10% chloral hydrate 30ml enema, 6h alternating use; control the onset of 1 to 2 days after the use of phenytoin (phenytoin) or carbamazepine oral, to maintain 2 to 3 month to prevent recurrence.

Basic nursing

Hypertensive encephalopathy care

1, reasonable arrangements for work and rest time, life should be regular, to avoid excessive fatigue and mental stimulation. Should go to bed early, should not be too much before going to sleep and look at the exciting film and television programs. Sleep, work and rest time roughly each 1/3 pay attention to warm, it is appropriate to take warm water bath, water temperature around 40 to avoid cold, because the cold can cause capillaries, easy to make blood pressure.Que es anoxia diet requires low salt, low fat, low calorie, taboo tobacco and alcohol. Daily salt control in 10 grams or less, if the heart failure and edema, but also reduce the amount of salt. Patients such as more obese, but also to control the intake of fat, cholesterol and sugar to vegetarian vegetarian as well.

2, physical activity and physical exercise, is conducive to weight loss, reduce high blood lipids, to prevent arteriosclerosis, so that limbs muscle relaxation, blood vessels, is conducive to lower blood pressure.