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Hypertensive encephalopathy in patients with chronic renal failure caused by stopping antihypertensive agents: a report of two cases

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Abstract

We herein report two cases of patients with chronic kidney disease who developed hypertensive encephalopathy, which occurred after a sudden discontinuance of antihypertensive agents. Both patients underwent care at our hospital after experiencing neurological abnormalities. In both patients, magnetic resonance imaging (MRI) revealed edema in the cerebral white matter and cortices, basal ganglia, brainstem, and cerebellum. Though recently the number of reports about hypertensive encephalopathy has decreased, we describe two case reports and also review the pertinent literature.

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References

  1. Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996;334:494–500.

    Article  CAS  PubMed  Google Scholar 

  2. Schwartz RB, Jones KM, Kalina P, Bajakian RL, Mantello MT, Garada B, et al. Hypertensive encephalopathy: findings on CT, MR imaging, and SPECT imaging in 14 cases. AJR Am J Roentgenol. 1992;159:379–83.

    CAS  PubMed  Google Scholar 

  3. Strandgaard S, Paulson OB. Cerebral autoregulation. Stroke. 1984;15:413–6.

    CAS  PubMed  Google Scholar 

  4. Hauser RA, Lacey DM, Knight MR. Hypertensive encephalopathy. Magnetic resonance imaging demonstration of reversible cortical and white matter lesions. Arch Neurol. 1988;45:1078–83.

    CAS  PubMed  Google Scholar 

  5. Ito T, Sakai T, Inagawa S, Utsu M, Bun T. MR angiography of cerebral vasospasm in preeclampsia. AJNR Am J Neuroradiol. 1995;16:1344–6.

    CAS  PubMed  Google Scholar 

  6. Weidauer S, Gaa J, Sitzer M, Hefner R, Lanfermann H, Zanella FE. Posterior encephalopathy with vasospasm: MRI and angiography. Neuroradiology. 2003;45:869–76. Epub 2003 October 22.

    Article  CAS  PubMed  Google Scholar 

  7. Schaefer PW, Buonanno FS, Gonzalez RG, Schwamm LH. Diffusion-weighted imaging discriminates between cytotoxic and vasogenic edema in a patient with eclampsia. Stroke. 1997;28:1082–5.

    CAS  PubMed  Google Scholar 

  8. Weingarten K, Barbut D, Filippi C, Zimmerman RD. Acute hypertensive encephalopathy: findings on spin-echo and gradient-echo MR imaging. AJR Am J Roentgenol. 1994;162:665–70.

    CAS  PubMed  Google Scholar 

  9. Yasuda Y, Akiguchi I, Imai T, Sonobe M, Kage M. Hypertensive brainstem encephalopathy. Intern Med. 2003;42:1131–4.

    Article  PubMed  Google Scholar 

  10. Lim MH, Kim DW, Cho HS, Lee HJ, Kim HJ, Park KJ, et al. Isolated cerebellar reversible leukoencephalopathy syndrome in a patient with end stage renal disease. Intern Med. 2008;47:43–5.

    Article  PubMed  Google Scholar 

  11. Doi Y, Kimura F, Fujiyama T, Fujimura C, Nishina T, Sato T, et al. Hypertensive brainstem encephalopathy without parieto-occipital lesion—two case reports. Neurol Med Chir. 2006;46:75–9.

    Article  Google Scholar 

  12. Ikram MA, Vernooij MW, Hofman A, Niessen WJ, van der Lugt A, Breteler MM. Kidney function is related to cerebral small vessel disease. Stroke. 2008;39:55–61.

    Article  PubMed  Google Scholar 

  13. Kobayashi M, Hirawa N, Yatsu K, Kobayashi Y, Yamamoto Y, Saka S, et al. Relationship between silent brain infarction and chronic kidney disease. Nephrol Dial Transplant. 2009;24:201–7.

    Article  PubMed  Google Scholar 

  14. Baylis C. Nitric oxide deficiency in chronic kidney disease. Am J Physiol Renal Physiol. 2008;294:F1–9.

    Article  CAS  PubMed  Google Scholar 

  15. Endemann DH, Schiffrin EL. Endothelial dysfunction. J Am Soc Nephrol. 2004;15:1983–92.

    Article  CAS  PubMed  Google Scholar 

  16. Huber JD. Diabetes, cognitive function, and the blood–brain barrier. Curr Pharm Des. 2008;14:1594–600.

    Article  CAS  PubMed  Google Scholar 

  17. Wardlaw JM, Farrall A, Armitage PA, Carpenter T, Chappell F, Doubal F, et al. Changes in background blood–brain barrier integrity between lacunar and cortical ischemic stroke subtypes. Stroke. 2008;39:1327–32.

    Article  PubMed  Google Scholar 

  18. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;23(351):1296–305.

    Article  Google Scholar 

  19. Ogawa S, Mori T, Nako K, Kato T, Takeuchi K, Ito S. Angiotensin II type 1 receptor blockers reduce urinary oxidative stress markers in hypertensive diabetic nephropathy. Hypertension. 2006;47:699–705.

    Article  CAS  PubMed  Google Scholar 

  20. Fliser D, Buchholz K, Haller H. European trial on olmesartan and pravastatin in inflammation and atherosclerosis (EUTOPIA) investigators; antiinflammatory effects of angiotensin II subtype 1 receptor blockade in hypertensive patients with microinflammation. Circulation. 2004;110:1103–7.

    Article  CAS  PubMed  Google Scholar 

  21. Nanayakkara PW, Kiefte-de Jong JC, Ter Wee PM, Stehouwer CD, van Ittersum FJ, Olthof MR, et al. Randomized placebo-controlled trial assessing a treatment strategy consisting of pravastatin, vitamin E, and homocysteine lowering on plasma asymmetric dimethylarginine concentration in mild to moderate CKD. Am J Kidney Dis. 2009;53:41–50.

    Article  CAS  PubMed  Google Scholar 

  22. Matsui T, Arai H, Yuzuriha T, Yao H, Miura M, Hashimoto S, et al. Elevated plasma homocysteine levels and risk of silent brain infarction in elderly people. Stroke. 2001;32:1116–9.

    CAS  PubMed  Google Scholar 

  23. Bos MJ, van Goor ML, Koudstaal PJ, Dippel DW. Plasma homocysteine is a risk factor for recurrent vascular events in young patients with an ischaemic stroke or TIA. J Neurol. 2005;252:332–7.

    Article  CAS  PubMed  Google Scholar 

  24. Seshadri S, Wolf PA, Beiser AS, Selhub J, Au R, Jacques PF, et al. Association of plasma total homocysteine levels with subclinical brain injury: cerebral volumes, white matter hyperintensity, and silent brain infarcts at volumetric magnetic resonance imaging in the Framingham Offspring Study. Arch Neurol. 2008;65:642–9.

    Article  PubMed  Google Scholar 

  25. Takami S, Minami M, Nagata I, Namura S, Satoh M. Chemokine receptor antagonist peptide, viral MIP-II, protects the brain against focal cerebral ischemia in mice. J Cereb Blood Flow Metab. 2001;21:1430–5.

    Article  CAS  PubMed  Google Scholar 

  26. Minami M, Katayama T, Satoh M. Brain cytokines and chemokines: roles in ischemic injury and pain. J Pharmacol Sci. 2006;100:461–70.

    Article  CAS  PubMed  Google Scholar 

  27. Takami S, Minami M, Katayama T, Nagata I, Namura S, Satoh M. TAK-779, a nonpeptide CC chemokine receptor antagonist, protects the brain against focal cerebral ischemia in mice. J Cereb Blood Flow Metab. 2002;22:780–4.

    Article  CAS  PubMed  Google Scholar 

  28. Bartynski WS. Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. Am J Neuroradiol. 2008;29:1036–42.

    Article  CAS  PubMed  Google Scholar 

  29. Sacco RL, Toni D, Mohr JP. Classification of ischemic stroke. In: Barnett HJM, Mohr JP, Stein BM, editors. Stroke: pathophysiology, diagnosis, and management. 3rd ed. New York: Churchill Livingstone; 1998. p. 341–54.

    Google Scholar 

  30. Sheth RD, Riggs JE, Bodenstenier JB, Gutierrez AR, Ketonen LM, Ortiz OA. Parietal occipital edema in hypertensive encephalopathy: a pathogenic mechanism. Eur Neurol. 1996;36:25–8.

    Article  CAS  PubMed  Google Scholar 

  31. Rosso S, Mastropasqua M, Mosetti MA, Persegani C, Paggi A. Low doses of liquorice can induce hypertension encephalopathy. Am J Nephrol. 2000;20:145–8.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, Saiseikai Tondabayashi Hospital, 1-3-36 Kouyoudai, Tondabayashi, Osaka, 584-0082, Japan

    Mari Nakabou, Tatsuya Kai, Tetsuya Maeshima & Ken Kanamasa

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  1. Mari Nakabou
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  2. Tatsuya Kai
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  3. Tetsuya Maeshima
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  4. Ken Kanamasa
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Correspondence to Mari Nakabou.

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Nakabou, M., Kai, T., Maeshima, T. et al. Hypertensive encephalopathy in patients with chronic renal failure caused by stopping antihypertensive agents: a report of two cases. Clin Exp Nephrol 14, 256–262 (2010). https://doi.org/10.1007/s10157-009-0252-9

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  • DOI: https://doi.org/10.1007/s10157-009-0252-9

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