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Hypertensive Encephalopathy, Posterior Reversible Encephalopathy Syndrome, and Eclampsia

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Hypertension and Stroke

Part of the book series: Clinical Hypertension and Vascular Diseases ((CHVD))

Abstract

Despite the efforts made to improve public health over the past decades, hypertension continues to affect a third of US adults older than 20 years of age. Since the 1970s, better strategies targeting cardiovascular risk factors have resulted in declining stroke incidence and mortality for all ages and races. However, the high prevalence of hypertension in selected groups is associated with increasing incidence of hypertensive emergencies. Therefore, greater effort to control this disease is still needed (Go et al. Circulation 127(1):143–52, 2013; Polgreen et al. Hypertension 65(5):1002–7, 2015). Close monitoring of blood pressure and effective treatment when elevated can prevent permanent disability from neurological emergencies such as hypertensive encephalopathy, intracranial hemorrhage, posterior reversible encephalopathy syndrome, and eclampsia related to pregnancy-induced hypertension.

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References

  1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al. Executive summary: heart disease and stroke statistics—2013 update: a report from the American heart association. Circulation. 2013;127(1):143–52.

    Article  PubMed  Google Scholar 

  2. Polgreen LA, Suneja M, Tang F, Carter BL, Polgreen PM. Increasing trend in admissions for malignant hypertension and hypertensive encephalopathy in the United States. Hypertension. 2015;65(5):1002–7.

    Article  CAS  PubMed  Google Scholar 

  3. Go AS, Bauman MA, Coleman King SM, Fonarow GC, Lawrence W, Williams KA, et al. An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. J Am Coll Cardiol. 2014;63(12):1230–8.

    Article  PubMed  Google Scholar 

  4. Rosenberg EF. The brain in malignant hypertension: a clinicopathologic study. Arch Intern Med. 1940;65(3):545–86.

    Article  Google Scholar 

  5. Volhard FFTH. Die Brightsche Neirenkrankheir, KlinikPathologie Und Atlas, vol. 2. Berlin: Springer; 1914.

    Book  Google Scholar 

  6. Keith Nm WHKJ. The syndrome of malignant hypertension. Arch Intern Med. 1928;41(2):141–88.

    Article  Google Scholar 

  7. Oppenheimer Bs FA. Hypertensive encephalopathy. Arch Intern Med. 1928;41(2):264–78.

    Article  Google Scholar 

  8. Pak KJ, Hu T, Fee C, Wang R, Smith M, Bazzano LA. Acute hypertension: a systematic review and appraisal of guidelines. Ochsner J. 2014;14(4):655–63.

    PubMed  PubMed Central  Google Scholar 

  9. Shorr AF, Zilberberg MD, Sun X, Johannes RS, Gupta V, Tabak YP. Severe acute hypertension among inpatients admitted from the emergency department. J Hosp Med. 2012;7(3):203–10.

    Article  PubMed  Google Scholar 

  10. Pinna G, Pascale C, Fornengo P, Arras S, Piras C, Panzarasa P, et al. Hospital admissions for hypertensive crisis in the emergency departments: a large multicenter Italian study. PLoS One. 2014;9(4), e93542.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Katz JN, Gore JM, Amin A, Anderson FA, Dasta JF, Ferguson JJ, et al. Practice patterns, outcomes, and end-organ dysfunction for patients with acute severe hypertension: the Studying the Treatment of Acute hyperTension (STAT) registry. Am Heart J. 2009;158(4):599–606.e1.

    Article  PubMed  Google Scholar 

  12. Gore JM, Peterson E, Amin A, Anderson Jr FA, Dasta JF, Levy PD, et al. Predictors of 90-day readmission among patients with acute severe hypertension. The cross-sectional observational Studying the Treatment of Acute hyperTension (STAT) study. Am Heart J. 2010;160(3):521–7.e1.

    Article  PubMed  Google Scholar 

  13. Ahmed ME, Walker JM, Beevers DG, Beevers M. Lack of difference between malignant and accelerated hypertension. Br Med J (Clin Res Ed). 1986;292(6515):235–7.

    Article  CAS  Google Scholar 

  14. Lip GY, Beevers M, Beevers DG. Complications and survival of 315 patients with malignant-phase hypertension. J Hypertens. 1995;13(8):915–24.

    Article  CAS  PubMed  Google Scholar 

  15. Webster J, Petrie JC, Jeffers TA, Lovell HG. Accelerated hypertension—patterns of mortality and clinical factors affecting outcome in treated patients. Q J Med. 1993;86(8):485–93.

    Article  CAS  PubMed  Google Scholar 

  16. Manning L, Robinson TG, Anderson CS. Control of blood pressure in hypertensive neurological emergencies. Curr Hypertens Rep. 2014;16(6):436. doi:10.1007/s11906-014-0436-x.

    Article  PubMed  Google Scholar 

  17. Gardner CJ, Lee K. Hyperperfusion syndromes: insight into the pathophysiology and treatment of hypertensive encephalopathy. CNS Spectr. 2007;12(1):35–42.

    Article  PubMed  Google Scholar 

  18. Healton EB, Brust JC, Feinfeld DA, Thomson GE. Hypertensive encephalopathy and the neurologic manifestations of malignant hypertension. Neurology. 1982;32(2):127–32.

    Article  CAS  PubMed  Google Scholar 

  19. Elliott WJ. Clinical features in the management of selected hypertensive emergencies. Prog Cardiovasc Dis. 2006;48(5):316–25.

    Article  PubMed  Google Scholar 

  20. Muiesan ML, Salvetti M, Amadoro V, di Somma S, Perlini S, Semplicini A, et al. An update on hypertensive emergencies and urgencies. J Cardiovasc Med (Hagerstown). 2015;16(5):372–82.

    Article  Google Scholar 

  21. Zampaglione B, Pascale C, Marchisio M, Cavallo-Perin P. Hypertensive urgencies and emergencies. Prevalence and clinical presentation. Hypertension. 1996;27(1):144–7.

    Article  CAS  PubMed  Google Scholar 

  22. Pancioli AM. Hypertension management in neurologic emergencies. Ann Emerg Med. 2008;51(3 Suppl):S24–7.

    Article  PubMed  Google Scholar 

  23. 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. 2004;110(15):2241–5.

    Article  PubMed  Google Scholar 

  24. Paulson OB, Waldemar G, Schmidt JF, Strandgaard S. Cerebral circulation under normal and pathologic conditions. Am J Cardiol. 1989;63(6):2C–5.

    Article  CAS  PubMed  Google Scholar 

  25. Cipolla MJ. Chapter 5: Control of cerebral blood flow. The Cerebral Circulation 2009. San Rafael (CA): Morgan & Claypool Life Science.

    Google Scholar 

  26. Verhaar MC, Beutler JJ, Gaillard CA, Koomans HA, Fijnheer R, Rabelink TJ. Progressive vascular damage in hypertension is associated with increased levels of circulating P-selectin. J Hypertens. 1998;16(1):45–50.

    Article  CAS  PubMed  Google Scholar 

  27. Blumenfeld JD, Laragh JH. Management of hypertensive crises: the scientific basis for treatment decisions. Am J Hypertens. 2001;14(11 Pt 1):1154–67.

    Article  CAS  PubMed  Google Scholar 

  28. Aggarwal M, Khan IA. Hypertensive crisis: hypertensive emergencies and urgencies. Cardiol Clin. 2006;24(1):135–46.

    Article  PubMed  Google Scholar 

  29. Strandgaard S, Jones JV, MacKenzie ET, Harper AM. Upper limit of cerebral blood flow autoregulation in experimental renovascular hypertension in the baboon. Circ Res. 1975;37(2):164–7.

    Article  CAS  PubMed  Google Scholar 

  30. Barry DI. Cerebral blood flow in hypertension. J Cardiovasc Pharmacol. 1985;7 Suppl 2:S94–8.

    Article  PubMed  Google Scholar 

  31. Paulson OB, Strandgaard S, Edvinsson L. Cerebral autoregulation. Cerebrovasc Brain Metab Rev. 1990;2(2):161–92.

    CAS  PubMed  Google Scholar 

  32. 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(2):379–83.

    Article  CAS  PubMed  Google Scholar 

  33. Schwartz RB, Mulkern RV, Gudbjartsson H, Jolesz F. Diffusion-weighted MR imaging in hypertensive encephalopathy: clues to pathogenesis. AJNR Am J Neuroradiol. 1998;19(5):859–62.

    CAS  PubMed  Google Scholar 

  34. Hinchey JA. Reversible posterior leukoencephalopathy syndrome: what have we learned in the last 10 years? Arch Neurol. 2008;65(2):175–6.

    Article  PubMed  Google Scholar 

  35. Jauch EC, Saver JL, Adams HP, Bruno A, Demaerschalk BM, Khatri P, et al. Guidelines for the early management of patients with acute ischemic stroke a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870–947.

    Article  PubMed  Google Scholar 

  36. Bakker RC, Verburgh CA, van Buchem MA, Paul LC. Hypertension, cerebral oedema and fundoscopy. Nephrol Dial Transplant. 2003;18(11):2424–7.

    Article  PubMed  Google Scholar 

  37. Kinoshita T, Moritani T, Shrier DA, Hiwatashi A, Wang HZ, Numaguchi Y, et al. Diffusion-weighted MR imaging of posterior reversible leukoencephalopathy syndrome: a pictorial essay. Clin Imaging. 2003;27(5):307–15.

    Article  PubMed  Google Scholar 

  38. Schneider JP, Krohmer S, Gunther A, Zimmer C. Cerebral lesions in acute arterial hypertension: the characteristic MRI in hypertensive encephalopathy. Rofo. 2006;178(6):618–26.

    Article  CAS  PubMed  Google Scholar 

  39. Fugate JE, Claassen DO, Cloft HJ, Kallmes DF, Kozak OS, Rabinstein AA. Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings. Mayo Clin Proc. 2010;85(5):427–32.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Price RS, Kasner SE. Hypertension and hypertensive encephalopathy. Handb Clin Neurol. 2014;119:161–7.

    Article  PubMed  Google Scholar 

  41. Beausang-Linder M, Bill A. Cerebral circulation in acute arterial hypertension—protective effects of sympathetic nervous activity. Acta Physiol Scand. 1981;111(2):193–9.

    Article  CAS  PubMed  Google Scholar 

  42. Edvinsson L, Owman C, Sjo N-O. Autonomic nerves, mast cells, and amine receptors in human brain vessels. A histochemical and pharmacological study. Brain Res. 1976;115(3):377–93.

    Article  CAS  PubMed  Google Scholar 

  43. Le EM, Loghin ME. Posterior reversible encephalopathy syndrome: a neurologic phenomenon in cancer patients. Curr Oncol Rep. 2014;16(5):1–9.

    Article  Google Scholar 

  44. Bartynski WS. Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. AJNR Am J Neuroradiol. 2008;29(6):1036–42.

    Article  CAS  PubMed  Google Scholar 

  45. Porcello Marrone LC, Gadonski G, de Oliveira Laguna G, Poli-de-Figueiredo CE, da Costa BE P, Lopes MF, et al. Blood-brain barrier breakdown in reduced uterine perfusion pressure: a possible model of posterior reversible encephalopathy syndrome. J Stroke Cerebrovasc Dis. 2014;23(8):2075–9.

    Article  PubMed  Google Scholar 

  46. Thomas L. Managing hypertensive emergencies in the ED. Can Fam Physician. 2011;57(10):1137–97.

    PubMed  PubMed Central  Google Scholar 

  47. Marik PE, Varon J. Hypertensive crises: challenges and management. CHEST J. 2007;131(6):1949–62.

    Article  CAS  Google Scholar 

  48. Varon J. The diagnosis and treatment of hypertensive crises. Postgrad Med. 2009;121(1):5–13.

    Article  PubMed  Google Scholar 

  49. Perez M, Musini V. Pharmacological interventions for hypertensive emergencies: a Cochrane systematic review. J Hum Hypertens. 2008;22(9):596–607.

    Article  CAS  PubMed  Google Scholar 

  50. McAllister R, Schloemer GL, Hamann SR. Kinetics and dynamics of calcium entry antagonists in systemic hypertension. Am J Cardiol. 1986;57(7):D16–21.

    Article  Google Scholar 

  51. Maxwell CJ, Hogan DB, Campbell NR, Ebly EM. Nifedipine and mortality risk in the elderly: relevance of drug formulation, dose and duration. Pharmacoepidemiol Drug Saf. 2000;9(1):11–23.

    Article  CAS  PubMed  Google Scholar 

  52. Shepherd AM, Ludden TM, McNay JL, Lin MS. Hydralazine kinetics after single and repeated oral doses. Clin Pharmacol Ther. 1980;28(6):804–11.

    Article  CAS  PubMed  Google Scholar 

  53. Kondo T, Brock M, Bach H. Effect of intra-arterial sodium nitroprusside on intracranial pressure and cerebral autoregulation. Jpn Heart J. 1984;25(2):231–7.

    Article  CAS  PubMed  Google Scholar 

  54. Schulz V. Clinical pharmacokinetics of nitroprusside, cyanide, thiosulphate and thiocyanate. Clin Pharmacokinet. 1984;9(3):239–51.

    Article  CAS  PubMed  Google Scholar 

  55. Vesey C, Cole P, Simpson P. Cyanide and thiocyanate concentrations following sodium nitroprusside infusion in man. Br J Anaesth. 1976;48(7):651–60.

    Article  CAS  PubMed  Google Scholar 

  56. Padilla Ramos A, Varon J. Current and newer agents for hypertensive emergencies. Curr Hypertens Rep. 2014;16(7):450. doi:10.1007/s11906-014-0450-z.

    Article  PubMed  Google Scholar 

  57. Pearce CJ, Wallin JD. Labetalol and other agents that block both alpha-and beta-adrenergic receptors. Cleve Clin J Med. 1994;61(1):59–69.

    Article  CAS  PubMed  Google Scholar 

  58. Amenta F, Tomassoni D, Traini E, Mignini F, Veglio F. Nicardipine: a hypotensive dihydropyridine-type calcium antagonist with a peculiar cerebrovascular profile. Clin Exp Hypertens. 2008;30(8):808–26.

    Article  CAS  PubMed  Google Scholar 

  59. Wood AJ, Murphy MB, Murray C, Shorten GD. Fenoldopam—a selective peripheral dopamine-receptor agonist for the treatment of severe hypertension. N Engl J Med. 2001;345(21):1548–57.

    Article  Google Scholar 

  60. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20.

    Article  CAS  PubMed  Google Scholar 

  61. American College of Obstetricians and Gynecologists, Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013;122(5):1122–31.

    Article  Google Scholar 

  62. Bell MJ. A historical overview of preeclampsia-eclampsia. J Obstet Gynecol Neonatal Nurs. 2010;39(5):510–8.

    Article  PubMed  PubMed Central  Google Scholar 

  63. World Health Organization. WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia: evidence base. 2011. http://apps.who.int/iris/bitstream/10665/44703/1/9789241548335_eng.pdf

  64. Berhan Y, Berhan A. Should magnesium sulfate be administered to women with mild pre-eclampsia? A systematic review of published reports on eclampsia. J Obstet Gynaecol Res. 2015;41(6):831–42.

    Article  CAS  PubMed  Google Scholar 

  65. Souza JP, Gulmezoglu AM, Vogel J, Carroli G, Lumbiganon P, Qureshi Z, et al. Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional study. Lancet. 2013;381(9879):1747–55.

    Article  PubMed  Google Scholar 

  66. Edlow JA, Caplan LR, O’Brien K, Tibbles CD. Diagnosis of acute neurological emergencies in pregnant and post-partum women. Lancet Neurol. 2013;12(2):175–85.

    Article  PubMed  Google Scholar 

  67. Eiland E, Nzerue C, Faulkner M. Preeclampsia 2012. J Pregnancy. 2012;2012:1–7.

    Article  Google Scholar 

  68. Altman D, Carroli G, Duley L, Farrell B, Moodley J, Neilson J, et al. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Lancet. 2002;359(9321):1877–90.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Neurology, Loyola University Medical Center, Maywood, IL, USA

    Karen Orjuela M.D.

  2. Department of Neurology, Stritch School of Medicine, Loyola University Chicago, 2160 S. First Ave., Maywood, IL, 60153, USA

    Sean D. Ruland D.O.

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  1. Karen Orjuela M.D.
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  2. Sean D. Ruland D.O.
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Correspondence to Sean D. Ruland D.O. .

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Editors and Affiliations

  1. Departments of Neurological Surgery and Neurology and Neurotherapeutics , University of Texas Southwestern Medical Center , Dallas, Texas, USA

    Venkatesh Aiyagari

  2. Michigan State University Department of Translational Science & Molecular Medicine, Mercy Health Hauenstein Neurosciences, Grand Rapids, Michigan, USA

    Philip B. Gorelick

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Orjuela, K., Ruland, S.D. (2016). Hypertensive Encephalopathy, Posterior Reversible Encephalopathy Syndrome, and Eclampsia. In: Aiyagari, V., Gorelick, P. (eds) Hypertension and Stroke. Clinical Hypertension and Vascular Diseases. Humana Press, Cham. https://doi.org/10.1007/978-3-319-29152-9_9

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  • DOI: https://doi.org/10.1007/978-3-319-29152-9_9

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