Acute hypertensive encephalopathy: symptoms, diagnosis, treatment

Hypertensive encephalopathy is an acute (less often chronic) severe malnutrition of the brain against the background of a simultaneous jump in blood pressure. This disorder is a complication of hypertension.

How quickly it occurs in a particular patient is a controversial issue and depends on many factors. Encephalopathy is accompanied by a difficult general situation. It is considered a pre-stroke condition, therefore, if the development of such a serious complication is suspected, urgent hospitalization in a hospital is required.

The effectiveness of primary measures and further therapy depends on many factors. Therefore, the prospects for recovery are vague.

There are no uniform statistics, but the mortality rate of hypertensive encephalopathy, or rather what it entails - stroke, is extremely high.

Development mechanism

It is based on a group of violations. The patient may have a single factor or a system of them. In this case, the risks of a negative outcome, as well as the overall severity of the condition, are many times higher.

In all cases, the direct culprit of the pathological process is a stable increase in blood pressure, and the retention of equally high numbers for a long time. Risks begin to increase from the range of 150/90 mmHg and above.

Instability of blood pressure leads to a reflexive further narrowing of the arteries that supply cerebral tissue. Dysfunction itself causes precisely the same reason.

The vessels lose their normal tone as a result of a biochemical reaction and the release of large amounts of angiotensin-2, renin, aldosterone, and cortisol. It is also possible that there is a violation of the regulation of arterial tone on the part of the nervous system.

The pressure continues to rise. The brain does not receive enough nutrients and oxygen. In particularly difficult cases, the risks of vessel rupture and hemorrhage are high.

But hypertension itself does not exist in isolation. It has a lot of reasons, fundamental mechanisms of the pathological process.

For example, narrowing of the lumen of the arteries as a result of the deposition of cholesterol plaques on their walls. This is the so-called atherosclerosis.

Or constant narrowing, decreasing diameter as a result of chronic spasm. As happens with experienced smokers and alcohol drinkers. This is just the tip of the iceberg.

Further, the process accelerates development.

Acute hypertensive encephalopathy begins suddenly and proceeds aggressively. From the moment of the first symptoms to a critical condition (stroke) it can take only a few hours or even less.

The diameter of the vessels continues to decrease, and the blood has to overcome greater resistance. The body seeks to compensate for insufficient trophism (nutrition) by increasing blood pressure. It's a vicious circle. If it is not broken, the death of cerebral structures cannot be avoided.

Knowing the patterns of development of hypertensive encephalopathy, it is possible to urgently plan treatment and increase the patient’s chances of survival.

There is also a chronic type of the disease. It is provoked by the same mechanisms, but is formed sluggishly. For several months, or even years.

This is a definite plus, because there is time for high-quality diagnostics and full-fledged treatment.

Hypertensive crisis

In hypertensive crises, when the disease becomes acute, serious consequences are possible.

Acute hypertensive encephalopathy leads to the following changes in the body:

• Severe mental disturbance.
• Tissue necrosis.
• The functioning of many organs is disrupted.

But, you can recover if you provide professional help in time.

Symptoms depending on stage

Practitioners and medical theorists distinguish three main phases of the pathological process.

First stage

Refers to the compensated form. Hemodynamic (blood flow) disturbances already exist; they are registered based on the results of Dopplerography of blood vessels, and an increase in blood pressure also makes itself known.

But so far the violation is not so critical. There is every chance of a full correction. In addition, the symptoms are barely noticeable.

Among the possible manifestations:

• Headache. Not strong, but monotonous and very annoying. Accompanies a person for a significant part of the day and occurs in attacks. It intensifies against the background of jumps in the tonometer reading. Therefore, it depends on vascular tone and is of arterial origin. By nature - aching or pulling, shooting. It is well relieved with analgesics.
• Dizziness and spatial disorientation. The patient feels that the world is spinning, but can still keep himself normal. Walk and even perform professional duties with almost no restrictions.
• Nausea, rarely vomiting.
• Weakness, drowsiness, asthenic phenomena. The pathological process is accompanied by a decrease in the quality of brain trophism. Nervous tissues are extremely “gluttonous” and require a lot of energy. The only way out is to minimize the required amount by transferring the cerebral structures to “standby mode.” Therefore, problems with intelligence and concentration develop. Lethargy.
• Behavioral disorders. So far the patient is at the level of irritability, tearfulness and increased aggressiveness.

In some cases, there are no symptoms at all at the first stage or they are extremely scarce. They intensify as encephalopathy transforms.

Second stage

Decompensation of the process. The body is still able to maintain cerebral blood flow, but not to its full extent. Neurological deficits become apparent.

Possible manifestations of the violation include:

• Severe headache. Excruciating. Usually short-term. Lasts about an hour or a little more. Variations are possible.
• Nausea, vomiting.
• Loss of consciousness.
• Syncope.
• Weakness, the same asthenic phenomena.
• Irritability.
• Decline in thinking abilities. Cognitive impairment is particularly common. First, as a type of decrease in productivity, and then they lead practically to dementia.
• There may be a decrease in motor activity. A person has less control over his own muscles. Faces, limbs. Although formally there are no paresis or paralysis.

The second stage of hypertensive encephalopathy is characterized by almost identical symptoms, but much more severe than in the first stage.

Quality treatment is still possible, although full recovery is not expected. Structural changes in the brain have already begun from a lack of nutrients and oxygen. They cannot be reversed.

There are, however, chances to bring the disease under control, eliminate symptoms and prevent further progression.

Third stage

Accompanied by decompensation. The patient's body can no longer correct problems with blood circulation. There is total dysfunction of the central nervous system. Efficiency drops to zero, the person becomes disabled.

Identical manifestations are detected, but in a critical form. The same neurological deficit puts an end to the ability not only to work, but even to social interaction. Including with loved ones.

Recovery is basically impossible. There are chances to partially eliminate the symptoms, but not the cause itself. The next natural outcome is a stroke and then death.

Regardless of the stage. There is always an objective disorder—high blood pressure. The numbers depend on the provocateurs, as well as the individual characteristics of the cardiovascular system of a particular patient.

Symptoms of hypertensive encephalopathy in the acute phase resemble those of a stroke. However, they are not very selective.

All parts of the brain are affected at once, the list of manifestations is as wide as possible:

• Strong headache. Covers the skull, accompanied by pulsation in time with the heartbeat. Does not go away throughout the entire period of the condition. Doesn't respond well to medications. Even powerful analgesics.
• Weakness, drowsiness. Asthenic manifestations. The opposite option also occurs. The patient rushes about, cannot find a place for himself. Restless, does not make contact. This is a so-called panic attack. It is accompanied by increased motor activity and a strong fear of death.
• Dizziness. Inability to navigate in space. The person is in a forced lying position. Any movement only makes it worse.
• Nausea and vomiting.
• Feeling of ringing and buzzing in the head and ears. A typical sign of a jump in blood pressure. Although, if the patient also has a serious illness, the manifestation may not be so noticeable.
• Darkening in the eyes, flickering of flies and bright flashing dots, spots in the field of vision. Visual manifestations are caused by irritation of the occipital lobe of the brain.
• Auditory hallucinations. Also, loss of the ability to perceive noise stimuli from one or both sides at once. Sign of damage to the temporal areas. At the same time, memory problems are possible for an identical reason.
• Cramps. Epileptic seizures.

Paresis and paralysis are not typical. This is more likely a manifestation of a full-fledged stroke.

Therefore, with the development of more serious signs, a revision of the possible diagnosis and urgent differentiation of various similar conditions is required.

Signs of a pre-stroke condition are described in detail in this article.

Causes

Encephalopathy of the hypertensive type develops as a result of a regular or constant increase in blood pressure. This has already been said.

But what causes the change in blood pressure itself in the long term?

• In women, gestosis is a common option. Late complication of pregnancy. Pre- and eclampsia. These are emergency conditions.
• Discontinuation of antihypertensive medications. Also a sharp transition to other means. May cause the opposite effect or withdrawal syndrome. It is accompanied by a multiple increase in the intensity of the symptoms of the disease that is intended to be kept in check.
• Kidney pathologies. So-called secondary arterial hypertension occurs.
• The primary form (essential) is caused by the actual problems of the heart and blood vessels. Without correction, even a level of 150/90 mmHg increases the likelihood of hypertensive encephalopathy by almost 35%.
• Endocrine disorders. In particular, adrenal dysfunction, such as hypercortisolism. Or the formation of a hormonally active tumor in the structure - pheochromocytoma.

• Alcohol abuse and constant smoking also have an impact. Consumers of tobacco products with a decent amount of experience risk many times more. Caffeine does not contribute to cardiovascular health. Atherosclerosis is another significant factor in the development of hypertensive encephalopathy.

Correcting the root cause will allow you to cope with the problem much faster and with better effect than dealing with symptoms.

Preventive measures

Based on the reasons, we can formulate a clear list of adequate measures:

• regularity and timely treatment of hypertension;
• treatment of chronic concomitant pathologies of diabetes - atherosclerosis, obesity;
• quitting smoking and alcohol;
• properly balanced diet;
• preventive administration of antioxidants and angioprotectors.

The main measure is to control pressure at an optimal level. This will help prevent the development of encephalopathy.

Since the development of headache goes through its 3 stages, almost every patient has encephalopathy at stage 3. Therefore, it is important to prevent hypertension from progressing to stage 3. It is important to eliminate night pressure surges and sharp background fluctuations during the day. It should be remembered that only the initial stage of violations is reversible. In the future, even correct treatment does not have an effect in reducing the impairment of mental and motor functions.

Diagnostics

The examination is carried out under the supervision of a cardiologist. You may also need the help of a neurologist and a vascular surgeon. The process under consideration is interdisciplinary.

An approximate list of methods:

• Oral interview with medical history. It is not always possible. If a person is in serious condition, you need to act quickly. Only after first aid has been provided can an in-depth examination of the patient be carried out.
• Blood pressure measurement. Indicators are usually extremely high or significantly higher than normal. What can be considered additional evidence in favor of hypertensive encephalopathy.
• Daily monitoring. Allows you to evaluate the dynamics of blood pressure and heart rate within 24 hours.
• Electroencephalography. It is carried out with the aim of studying brain rhythms and the activity of different parts of cerebral structures.
• ECG, ECHO. Methods for assessing the heart. Organic and functional disorders are identified.
• MRI if necessary. Used to identify changes in cerebral structures.
• Blood tests: hormones, general, sugar, biochemistry and others. Full laboratory evaluation.

Usually this is enough. If the need arises, other methods are prescribed.

Treatment

Therapy is carried out in a hospital setting. As soon as hypertensive encephalopathy is detected, a group of pharmaceuticals is prescribed.

The basis of treatment is the use of drugs:

• Cerebrovascular. In order to restore cerebral blood flow. Piracetam, Actovegin. Duration of use may be indefinite. Because often the cause of the disease is chronic and cannot be completely corrected.
• Nootropics. They accelerate metabolic processes, which reduces the need for oxygen and improves brain function. Phenibut, Glycine and analogues.
• Antihypertensive. Means for normalizing blood pressure. For urgent help, use Kapoten and other similar ones. But they have a pronounced effect, so the dosage must be selected carefully so as not to provoke a sharp drop in blood pressure.

A too rapid decrease will lead to a critical lack of oxygen supply to nerve tissues. Possible stroke.

The safe rate of normalization is no more than 15-20% within an hour of the initial value.

For long-term use, beta blockers (Anaprilin), calcium antagonists (Verapamil, Diltiazem) are indicated.

• Diuretics. Diuretics. Furosemide, Torasemide, others if necessary.
• Antispasmodics. They relieve vasoconstriction. Papaverine or Dibazol. Both medications are powerful. They are used by ambulance teams or doctors in hospital settings. Independent use strictly with the prescription of specialists.
• Sedatives. Not always. Only when necessary. Tranquilizers are addictive and depress the nervous system too much, which can be dangerous.
• Anticonvulsants. If there is such a need.

After recovery from the acute condition and compensation, you need to undergo a rehabilitation course.

It is mandatory for the patient to give up smoking, alcohol, and the unauthorized use of any medications, and limit the consumption of salt (up to 7 grams) and sugar. Eliminate fatty and fried foods from the diet in principle.

It would also be a good idea to optimize your physical activity. Walking or exercise therapy are suitable. Each stage of recovery must be coordinated with a doctor.

Regular examinations by specialists are also indicated in the future. At least a neurologist and cardiologist. Every 3-6 months.

How to treat encephalopathy

As soon as the doctor receives the diagnostic results, he will be able to prescribe effective and competent therapy to the patient. When a patient has hypertensive encephalopathy, the specifics of treatment will depend on the stage of the disease, the body’s individual tolerance to certain medications, as well as the duration of medication use. Treatment must be carried out in combination and is aimed at reducing symptoms:

1. Initially, intensive therapy is prescribed. In this case, you can lower the pressure, but it is not recommended to do this too sharply; it is best to lower the pressure by 20 divisions per hour.
2. With the help of dehydrating drugs, blood circulation in the vascular system in the brain of the head is normalized. Thus, the patient will be able to prevent swelling of this organ. These drugs are diuretics.
3. Antispasmodics are prescribed by a doctor not only to relieve headaches, but also to improve blood circulation.
4. Neuroprotectors are prescribed to protect nerve cells in the brain from destruction. This group may include vitamins and antioxidants.
5. It will not be possible to do without taking sedatives. This includes antidepressants and antipsychotics. Only with these drugs can one stabilize the general condition of a person and relieve the existing overexcitation.
6. Anticonvulsant medications are prescribed only if seizures occur.

You should not count on quick treatment, since hypertensive encephalopathy takes a long time to eliminate. Only if the patient follows all the doctor’s instructions can we talk about favorable prognosis for recovery.