Hypertensive encephalopathy code according to ICD 10

Hypertensive encephalopathy is a pathology that develops as a result of impaired cerebral blood flow against the background of arterial hypertension, which occurs in an acute form. Manifests itself as general brain dysfunction. Accompanied by increasing neurological deficit. Encephalopathy is an organic lesion of brain structures of non-inflammatory etiology. Hypertensive encephalopathy is included in the international list of diseases of ICD-10 in subsection 167 “Cerebrovascular diseases” under number 167.4.

How does hypertension affect brain cells?

Even a one-time surge in pressure for the brain does not pass without a trace. Regulation of the tone of venules and arterioles is impaired. The target becomes not only the brain, but also the heart and kidneys. With a slight increase in pressure, a protective spasm of small vessels is first triggered. The body does this to prevent their rupture and pressure.

If the pressure remains elevated for a long time, the muscle layer of the blood vessels begins to hypertrophy. The result is a narrowing of the lumen of the vessel and a decrease in blood perfusion. Hypoxia occurs to varying degrees. The brain is the most sensitive to hypoxia. Which causes neurological symptoms.

Thus, with HE of any form, the hemodynamics of the brain are disrupted, and damage to brain tissue occurs, including necrosis. All this occurs against the background of long-term hypertension, which is difficult to control.

Acute hypertensive encephalopathy according to the ICD is identified as a separate type of encephalopathy that occurs with symptomatic hypertension. At first, predominantly small vessels are affected, but the pathology quickly begins to combine with the involvement of other calibers. This form usually manifests itself against the background of a hypertensive crisis. According to ICD-10, acute hypertensive encephalopathy has the following code - I67.4. In this case, the level of pressure may differ between hypo- and hypertensive patients.

For hypertensive patients, dangerous numbers range from 180-190 mm Hg. Art., and in hypotensive patients - within 140/90. In any case, we are talking about increasing the norm.

Experts call this condition of hypertensive encephalopathy a peculiar manifestation of a hypertensive crisis. The chronic form of the pathology is more common.

Hypertensive encephalopathy (hypertensive) - what is it, its symptoms, ICD 10 code, treatment

Hypertensive (hypertensive) encephalopathy is a circulatory disorder in the structures of the brain, provoked by a severe form of arterial hypertension. In ICD-10 pathology, a separate code I67.4 is allocated - hypertensive encephalopathy.

With consistently high levels of blood pressure, brain tissue begins to experience oxygen deficiency and die, as a result of which a person’s general cerebral activity is disrupted and dangerous symptoms appear.

The disease can occur in a chronic or acute form, and the risk of complications depends on the timeliness of treatment.

The main factor causing hypertensive encephalopathy is a sharp increase in blood pressure. Diseases and pathologies that provoke such an increase include:

a malignant form of arterial hypertension, which occurs most often in young and middle-aged people;
kidney diseases - acute form of nephritis, renal artery thrombosis;
endocrine disorders - Cushing's syndrome;
eclampsia during pregnancy;
pheochromocytoma - a benign formation in the adrenal glands;
hypertensive crisis.

A sharp increase in pressure that occurs against the background of the described diseases causes dyscirculatory disorders in the vessels supplying the brain with blood. As a result, after each attack, areas of ischemia are formed in the brain tissue, which disrupt the functioning of the nerve endings concentrated in this area.

Symptoms and signs of the disease

Signs of hypertensive encephalopathy of chronic and acute forms are significantly different.

In acute illness, the patient rapidly develops the following symptoms:

a sharp increase in blood pressure to critical levels;
a painful attack of headache, aggravated by tensing the abdominal muscles, coughing or sneezing;
repeated, sudden vomiting;
numbness of the limbs and uncontrollability of movements;
convulsions and sharp muscle spasms of the limbs;
impaired consciousness, fainting;
negative reaction to bright light, touching the skin;
visual disturbances - swelling of the nerves, hemorrhage in the retina.

In the absence of proper medical care for acute hypertensive encephalopathy, there is a high risk of coma with subsequent death.

The chronic form of the disease does not begin to manifest itself immediately. At the initial stage, neurological symptoms are periodically disturbing, and their insignificance leads to an erroneous diagnosis. During this period, the patient may experience:

bursting headaches, dizziness;
decreased concentration and memory;
weakness, lethargy, increased fatigue.

The second stage of hypertensive encephalopathy is characterized by the severity of symptoms. The following are added to the signs that develop at the initial stage:

movement disorders;
coordination disorders;
impairment of intelligence and mental functions;
psycho-emotional disorders (mood swings, attacks of fear, aggression, irritability).

The last stage of chronic disease is the most serious. The massive number of foci of affected brain cells leads to the development of the following symptoms and aggravating consequences:

memory loss;
progressive dementia;
loss of everyday and social skills;
limitation or complete absence of work capacity and ability to self-care.

If a diagnosis is made at the initial stage and treatment is started, the progression of the disease can be stopped. At subsequent stages, damage to brain tissue becomes irreversible, so doctors prescribe therapeutic measures only to maintain brain activity and relieve symptoms.

Treatment of hypertensive encephalopathy

To determine the size of lesions in brain tissue, as well as the degree of brain atrophy in hypertensive encephalopathy, a neurologist prescribes one of the following types of examinations:

Dopplerography;
Ultrasound of blood vessels and brain structures;
Brain MRI.

Also, during diagnosis, additional studies are prescribed aimed at identifying the causes of the disease, for example, assessing the condition of the cardiac and endocrine systems, kidneys. If a patient is diagnosed with pathologies that contribute to the development of hypertensive encephalopathy, then drugs with the appropriate mechanism of action are included in the treatment regimen.

When composing a treatment regimen, the attending physician takes into account the form and stage of hypertensive encephalopathy.

In the acute course of the disease, treatment is carried out in a hospital under intensive care conditions. The patient is urgently prescribed medications in the form of intravenous drips:

rapid-acting antihypertensive drugs;
diuretics;
magnesium sulfate.

When the condition stabilizes, the injections are replaced with tablets, while adjusting the dosage and regimen of the drugs.

Treatment of the chronic form of hypertensive encephalopathy should be systematic. Depending on the diagnostic results and the degree of symptoms, the patient must undergo a course of treatment once or twice a year, which may include the following:

drugs that lower blood cholesterol;
neuroprotectors that promote better blood supply to the brain;
drugs that strengthen vascular walls;
blood thinners;
drugs that restore the relationship between nerve cells.

With hypertensive encephalopathy, it is important not only to take the treatment prescribed by the doctor, but also to change some aspects in everyday life.

In consultation with the doctor, you should adhere to a low-cholesterol diet, stop smoking and drinking alcohol, normalize your daily routine, while allocating optimal time for rest and sleep.

If the disease has progressed to an advanced form, the patient is additionally prescribed supportive therapy, including massages and physical therapy, and the use of non-traditional techniques (for example, manual therapy, acupuncture). Incapacitated patients will require the assistance of relatives or a caregiver to perform daily household tasks.

Ivan Drozdov, neurologist

The information on the site is created for those who need a qualified specialist, without disturbing the usual rhythm of their own lives.

Source: https://progolovy.ru/golovnoj-mozg/gipertonicheskaya-encefalopatiya

GE in acute form

Acute HE is an emergency condition and immediate assistance is required. Otherwise, complications are required in the form of cerebral edema, hemorrhagic stroke, heart attack, and death.

Acute hypertensive encephalopathy according to ICD-10 has the code I67.4. Discirculatory vascular hypertensive encephalopathy is considered a separate manifestation. It is possible at any age.

Pathology occurs against the background of hypertension - crises. An exacerbation against their background in the form of GE is such a chain. Its progression is more rapid than that of other forms of discirculatory encephalopathy.

The diagnosis of “dyscirculatory hypertensive encephalopathy” is made when there is chronic damage to brain tissue due to insufficient blood supply. Its development is gradual and progressive. It is accompanied by morphological changes in brain tissue, impaired functionality and can cause dementia, incapacity and disability.

Hypertensive encephalopathy code according to ICD 10

The disease can occur in a chronic or acute form, and the risk of complications depends on the timeliness of treatment.

Causes of pathology

The main factor causing hypertensive encephalopathy is a sharp increase in blood pressure. Diseases and pathologies that provoke such an increase include:

a malignant form of arterial hypertension, which occurs most often in young and middle-aged people;
kidney diseases - acute form of nephritis, renal artery thrombosis;
endocrine disorders - Cushing's syndrome;
eclampsia during pregnancy;
pheochromocytoma - a benign formation in the adrenal glands;
hypertensive crisis.

Short description

Hypertensive encephalopathy is a syndrome of cerebrovascular accident with neurological deficit caused by severe arterial hypertension. This is one of the life-threatening forms of target organ damage that can develop in a critical hypertensive state.

Clinical symptoms include headache, restlessness, nausea, vomiting, confusion and seizures. Lowering blood pressure usually leads to rapid improvement. The diagnosis seems doubtful until the disappearance of neurological disorders against the background of a decrease in systemic blood pressure.

In this condition, brain damage is caused mainly by rapidly developing edema.

Protocol code: H-T-031 “Hypertensive encephalopathy” For therapeutic hospitals

ICD 10 code(s): I67.4 Hypertensive encephalopathy

Causes of the problem

The leading cause of HE (hypertensive encephalopathy according to the ICD is coded I67.4) is an advanced form of hypertension. It can be primary or secondary, that is, against the background of other diseases accompanied by pressure surges: kidney damage (chronic pyelonephritis, glomerulonephritis, hydronephrosis), hyperthyroidism.

An important point is the pathology of the adrenal glands and pituitary gland - pheochromocytomas, excessive function of the adrenal cortex or in the zona glomerulosa - aldosterone, aortic atherosclerosis.

For hypertensive patients, uncontrollable hypertension is dangerous; changes develop especially quickly when they stop taking antihypertensive drugs. Repeated crises of hypertension, in which the vessels quickly wear out and become thinner. Their permeability increases and rapid hemorrhagic impregnation of brain tissue occurs. Changes aimed at normalizing blood pressure and hypotension with slowing blood flow also occur. Nocturnal hypertension is often hidden.

High pulse pressure is another important factor. If the difference between the upper and lower pressures exceeds 40 mm Hg. Art. – the course of vascular diseases is aggravated. This pressure constantly affects the vascular wall and puts a strain on the muscular apparatus of the vascular wall.

Methods of therapy

How effective the treatment will be primarily depends on whether the blood pressure can be stabilized. Neurological therapy is carried out while taking antihypertensive drugs and treating the primary disease that provokes hypertension. Treatment of hypertensive encephalopathy is aimed at improving cerebral perfusion, restoring the functions of the central nervous system, and maintaining the metabolism of brain tissue. For this purpose the following are assigned:

Preparations to improve blood microcirculation. The course takes anticoagulants, for example dipyridamole, acetylsalicylic acid. Taking pentoxifylline can also improve microcirculation;
Vasodilators help relieve spasm of arterioles, that is, the main pathogenetic link in the development of GE. The choice of drugs should take into account the presence of side steal syndrome. It is necessary to focus on such medications as: calcium channel blockers, phosphodiesterase inhibitors, a2-adrenergic receptor antagonists;
Symptomatic drugs that are prescribed depending on the clinical picture accompanying encephalopathy. For hyperlipidemia, the prescription of statin drugs is indicated. If there is a decrease in cognitive abilities, taking nootropics is necessary. When mental abnormalities occur, mood stabilizers, sedative pharmaceuticals, and tranquilizers are needed. For epileptic paroxysms - anticonvulsants;
Neuroprotectors can increase the resistance of nerve cells to a reduced supply of nutrients and chronic hypoxia. This group of drugs includes antioxidants: lipoic acid, ethylmethylhydroxypyridine succinate and amino acid drugs: glycine, aminobutyric acid.

Risk factors

Risk factors include:

Deviations in the functioning of blood vessels and the heart that are not diagnosed in time.
Diseases of the kidneys (congenital or acquired) and brain.
Unstable condition of blood vessels. Overexertion of any type - physical and mental.
Incorrect or irregular treatment of hypertension.
Eating disorders and physical inactivity, bad habits.

Hypertensive encephalopathy (hypertensive encephalopathy according to ICD-10 code I67.4) can also be triggered by:

obesity, old age, diabetes;
refusal or switching to another antihypertensive drug without consulting a doctor;
eclampsia with edema, high blood pressure and proteinuria;
adrenal tumors;
addiction to certain drugs - steroids, caffeine, sports doping;
stress due to existing problems with blood vessels;
poor ecology can also do a disservice to vessels;
systematic hypothermia of the body.

Under certain conditions, the diagnosis of hypertensive encephalopathy (ICD code I67.4) can be made to any person.

Pathogenesis

When there is a shortage of nutrition delivered to the vessels, changes occur in their walls in the form of a decrease in their tone. Next comes the thickening of the muscles of the walls of blood vessels and their lumen narrows. Hypoxia gets worse. This, in turn, worsens the condition of the nerve fibers.

Spasm of cerebral arterioles leads to hypoxia and nutritional deficiency for brain cells, and chronic cerebral ischemia develops. Next, degenerative changes occur in the cerebral structures. If there is atherosclerosis, it only worsens the situation.

The white medulla is affected earlier than others; lacunar infarctions develop here and demyelination of nerve fibers occurs.

These changes are diffuse and affect both hemispheres symmetrically. The lesions first occur along the ventricles, then they expand their space and spread periventricularly.

Excessive spasm of small arterioles that pass into capillaries acquires immediate significance in the development of OGE; their permeability increases and paralysis and an acute form of EHE can develop.

Acute form

Hypertensive crisis with blood pressure above 180-190 mm Hg. Art. As a rule, it causes serious changes in vascular tissues. Which? When obstacles to its movement appear, namely: a narrowed lumen of a vessel or plaques on the walls, the blood reacts to this by the appearance of hemorrhages along the walls of the vessels. The tone of the veins of the soft meninges changes and intracranial pressure increases. It causes the appearance of neurological symptoms. Acute hypertensive encephalopathy is a consequence of a hypertensive crisis; but it also becomes a harbinger of strokes with subsequent development of disability and death. OGE accounts for 16% of crisis complications.

Forecast

A prognosis can only be made taking into account the stage of hypertensive encephalopathy, the possibility of complete pressure correction, the presence of an underlying disease or concomitant pathologies such as endocrine system disorders and atherosclerosis. In the first stage of GE, complex neurological treatment and stabilization of pressure can ensure the patient’s ability to work and long-term intellectual safety. And in stage III, therapy only slows down the progression of the disease and alleviates its manifestations.

Symptoms

The clinical picture of acute hypertensive encephalopathy includes:

Bursting unbearable headaches.
At first they are localized in the back of the head, then they become diffuse, i.e. are growing.
Analgesics do not relieve pain. This is often accompanied by nausea and vomiting without relief. Acute hypertensive encephalopathy occurs most often during a hypertensive crisis.
Vision suddenly deteriorates due to swelling of the optic nerve head, dark spots and spots appear before the eyes.
Severe dizziness. With coughing and sneezing and other tension in the neck muscles, the condition becomes even worse.
Hearing deteriorates - ringing and noise in the ears appear.
Cramps and meningeal symptoms occur without inflammatory changes (meningismus).
The threshold of surface sensitivity increases.

In general, these are symptoms of a hypertensive crisis, but with the involvement of brain dysfunction. In the absence of proper treatment, massive neuronal death occurs and new ischemic lesions appear.

The main clinical symptoms of acute hypertensive encephalopathy also include:

a state of stunning, which is preceded by excitement, turning into paresis;
slow heart rate;
numbness of the tip of the tongue, fingers, orientation in space is disturbed;
gait becomes unsteady.

Body temperature may rise. The attack may take several hours or last up to 2 days. Next, a hemorrhagic stroke develops, cerebral edema and death if assistance is not provided are guaranteed.

Acute hypertensive encephalopathy thus occupies an intermediate position between crisis and strokes.

The determining factor is the pressure numbers: during an attack it is up to 250-300, at the bottom – up to 130-170. But the vessels dilate. They no longer narrow, and their permeability increases. Blood flow in the brain tissue is disrupted, and with a deficiency of plasma, protein, and oxygen, brain edema develops. Small foci of necrosis develop.

Acute hypertensive encephalopathy is also one of the early signs of a stroke, so first of all the patient should be kept at rest and an ambulance should be called.

What is it - hypertensive encephalopathy. ICD code 10 hypertension syndrome

Any encephalopathy is a brain disease of a non-infectious and non-inflammatory nature, which leads to degenerative disorders of the nervous tissue. As a rule, it is diffuse in nature. This disease can be observed especially often in older people.

Increased pressure causes pathological disorders of blood vessels in the brain: adaptive thickening of the walls of extracerebral vessels, hemorrhagic and plasma impregnation, as well as necrosis of vascular tissues with their further thinning. That is, the lumen of blood vessels decreases, their walls thicken, which leads to disruption of the nutrition of brain cells.

Hypertensive encephalopathy, in contrast to atherosclerotic encephalopathy, is characterized by the fact that increased pressure causes the main damage to the medium and small vessels of the brain. However, the division of these pathologies is rather arbitrary.

High blood pressure is the main factor of destruction for the entire body; the main organs (heart, kidneys, liver) suffer from this.

It is hypertensive encephalopathy that, as a rule, is responsible for the occurrence of such serious diseases as dementia, stroke, and heart attack.

Causes of hypertensive encephalopathy

The main causes of the disease may be the following factors:

hypertensive crisis;
kidney dysfunction;
eclampsia (a form of toxicosis, a disease in late pregnancy).

Particularly severe complications are caused by a hypertensive crisis.

The causes of high blood pressure that lead to encephalopathy can be divided into acquired and congenital.

It has long been noted that the likelihood of hypertension in people increases significantly when one of the patient's parents suffered from this disease. Some doctors consider this pathology to be hereditary with a dominant transition.

But if we consider hereditary hypertension, then this type of disease is more typical for young people; in old age, the main role in its appearance is played by factors that are associated with a person’s lifestyle.

These include the following factors:

high blood cholesterol levels;
unhealthy habits;
severe mental stress and frequent stress;
chemical poisoning;
some diseases;
overdose of medical drugs.

Moreover, it cannot be said that problems with blood pressure necessarily lead to the appearance of encephalopathy, but the likelihood of this is high, and people who suffer from hypertension, regardless of its origin, must know this.

It should also be said that with constant high blood pressure, the disease does not appear so often: the blood vessels of the brain adapt to this, but sudden changes in pressure are much more dangerous.

This can cause cerebral vasospasm, which causes accumulation of cytotoxic substances and ischemia.

Pregnant women are also at risk; in the later stages they develop eclampsia (a type of toxicosis). This also includes people who suffer from glomerulonephritis and mature men who abuse alcohol.

Another disease that causes the development of hypertensive encephalopathy is endothelial dysfunction disease. With this disease, a very large number of platelets are formed in the body, which greatly increases the viscosity of the blood.

Stages and symptoms of hypertensive encephalopathy

The disease has three stages. The first stage is the easiest. Symptoms of the disease at each stage are slightly different. At later stages, the disease is irreversible, that is, it is impossible to completely eliminate its symptoms.

First stage

At this stage, the following symptoms are observed:

severe headaches, for which even analgesics cannot help;
dizziness;
noise or ringing in the ears;
constant fatigue;
hearing or vision impairment;
sleep disturbance;
decreased intellectual abilities, memory disorders.

The main problem of treatment is that patients rarely seek medical help at the first (initial) stage of the onset of the disease.

As a rule, these symptoms are not paid attention to, especially in old age, considering this to be the appearance of age-related changes or signs of other, less dangerous diseases. As a result, the disease moves to the next stage, which becomes more difficult to cure.

At the first stage, the disease can be cured and it is a reversible process . The patient can still be returned to a full and normal life.

Second phase

At this stage of the disease, the symptoms are the same, but become more pronounced and acute. Symptoms are added that are associated with a person’s psycho-emotional state: lethargy, sudden mood changes, apathy.

At the second stage, the person can no longer perform his usual work, it is difficult for the patient to engage in any activity, and the person gets tired very quickly.

, neurological symptoms are pronounced .

Third stage

At this stage of the disease, neurological symptoms become even more pronounced, the following syndromes appear:

extrapyramidal syndrome (tics, tremors of arms and legs, impaired muscle tone);
pseudobulbar syndrome (difficulty swallowing, problems with speech);
vestibulocerebellar syndrome.

A person may experience acute cognitive disorders , delusions, and hallucinations. This stage of the disease is quite fleeting, unfortunately, it often leads to disability or death.

During a hypertensive crisis, an acute stage of the disease may occur, which is very dangerous and is accompanied by the following symptoms:

vomiting, nausea;
dizziness;
loss of sensation in some areas of the body;
dysfunction of the sense organs;
convulsions;
hallucinations;
epileptic seizures.

The clinical picture of the acute stage of encephalopathy differs from the usual process of disease development in its unpredictability , severity and high speed of pathogenesis.

All of the above symptoms may appear against the background of anuria, heart failure, and pulmonary edema. The acute stage of the disease often leads to a strong increase in intracranial pressure and the rapid appearance of cerebral edema.

This stage of hypertensive encephalopathy appears when elevated blood pressure exceeds the body’s ability to maintain normal blood circulation in the brain, that is, the self-regulation of blood vessels in it is impaired. It must be said that a violation of self-regulation occurs at different pressure levels - this is individual for each person.

The symptoms of the acute stage of encephalopathy are quite similar to the symptoms of a stroke, especially since this disease is also caused by high blood pressure. The acute stage of the disease requires immediate action.

First of all, the patient needs to lower blood pressure and relieve brain swelling.

The acute stage of the disease progresses quite quickly, doctors have only a few days to provide assistance, otherwise coma and death occur.

Diagnosis of hypertensive encephalopathy

Diagnosis of this disease is carried out on the basis of the disease history, patient complaints, and general symptoms. The results of analyzes and studies are also taken into account. The difficulty of diagnosis may lie in the fact that the signs of encephalopathy are quite similar to the clinical picture of many other pathologies: strokes, brain tumors and some other diseases.

examinations need to be carried out :

MRI/CT helps determine cerebral edema;
urine and blood tests (general and advanced);
lumbar puncture;
echocardiography (to determine the condition of the left ventricle);
electroencephalography (to determine epileptic brain activity).

For diagnosis, the help of other doctors may be necessary: therapist, cardiologist, endocrinologist, nephrologist. They will be able to point out pathologies in other organs as a result of hypertension.

Treatment of hypertensive encephalopathy

Treatment for this disease consists of lowering blood pressure, as well as relieving the symptoms that caused the condition.

The acute stage of encephalopathy requires urgent hospitalization , as it is fatal. When lowering blood pressure, you must remember the following: when the pressure is chronically elevated (often happens in older people), then it must be lowered gradually, by approximately 20% in one hour of treatment. A sharp decrease leads to negative consequences.

At the first stage of the disease, treatment is much more effective, but the insidiousness of the disease is that there are no characteristic symptoms in the first stages.

Drug therapy consists of taking vascular agents, antihypertensive drugs, neuroprotectors, antiplatelet agents, tranquilizers, and antihypoxants. Secondary prevention and dehydration are also performed.

Anticonvulsants and painkillers are sometimes required. At the recovery stage, antioxidants and vitamin complexes are used.

In addition, hypertension also damages internal organs, so for successful treatment it is necessary to improve the person’s general condition.

Often, high blood pressure is accompanied by atherosclerosis , which is the result of a high amount of cholesterol in the blood. It is also a factor that causes encephalopathy. In this case, patients are prescribed a special diet that helps reduce blood lipid levels and normalize body weight.

Even with a positive result of treatment, the patient requires a long time to recover. In addition, at the slightest symptoms of the disease, a person must immediately seek help from a doctor.

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.

Source: https://pro-acne.ru/golova/chto-takoe-gipertenzivnaya-entsefalopatiya-simptomy-priznaki-i-lechenie-bolezni.html

Diagnostics

The diagnostic algorithm includes:

Mandatory examination by a neurologist. In the initial stage, the status may not be disturbed, but anisoreflexia occurs earlier than others. Special cognitive testing determines mnestic, praxic and gnostic disorders of varying degrees.
A consultation with a cardiologist will identify and confirm the presence of hypertension.
Mental status is assessed by a psychiatrist through conversation, observation and testing.
Diagnosis can be difficult due to the similarity of symptoms of cerebral accidents, so CT and MRI of the brain vessels need to be performed. In this case, focal changes are detected in the brain - cerebral edema. It also makes it possible to identify diffuse degenerative changes, foci of previous lacunar infarctions in patients with stages II-III of GE, and to exclude other organic pathologies of the brain. The blood test picture is not informative, but the presence of hypercholesterolemia is important.
On consultation with an ophthalmologist - swelling of the optic discs. There is an increase in pressure inside the skull.
EEG - disorganization of basic rhythms, especially in the occipital region. ECG – hypertrophy of the left ventricular wall, dystrophic changes in the myocardium.
Study of cerebral hemodynamics: ultrasound of the cervical and cranial vessels. This study reveals the degree of narrowing of arterioles, their location and extent.

Clinical manifestations

At the initial stage, slowly progressive nonspecific symptoms are observed. It includes:

Cephalgia;
Chronic fatigue;
Memory impairment;
Decreased concentration.

As the pathology develops, certain neurological syndromes appear. Dysmnestic syndrome is manifested by memory impairment. With a subcortical disorder, tremor, secondary parkinsonism, and hyperkinesis dominate. Vestibular is characterized by unsteadiness of gait, pyramidal - muscle weakness such as mild hemiparesis.

Also observed:

Narrowing the range of interests;
Deterioration in the speed and productivity of thinking;
Apraxia, that is, difficulties with organizing activities;
Motivation problems;
Increased emotional lability;
Problems in the cognitive sphere arise due to a lack of a critical attitude towards one’s own state;
Behavioral and affective disorders.

The clinical picture is characterized by a transient improvement of the condition and flickering of the symptomatic picture.

The third stage of the disease is accompanied by severe cognitive and organic disorders:

Agnosia;
Apraxia;
Dysarthria;
Decay of intellectual abilities;
Personality change;
Mental disorders;
Loss of professional skills;
Pseudobulbar palsy;
Vascular dementia with personality disorder;
Violent crying;
Swallowing disorder;
Epileptic paroxysms caused by lacunar infarctions;
Syncope;
Increases in ataxic, pyramidal and parkinsonian syndrome, which limit the possibility of household services and independent movement.

Treatment

The patient is subject to mandatory hospitalization in the intensive care unit and observation by a whole team of doctors: resuscitator, neurologist, neurosurgeon, ophthalmologist, etc.

Diagnosed OGE requires the use of long-acting drugs.

It is mandatory to prescribe diuretics that relieve swelling of brain tissue - Furosemide, ethacrynic acid, Lasix, etc. Control of blood electrolytes is also important to prevent total cerebral ischemia.

You cannot quickly reduce the existing pressure; the process must be gradual. During the first hour, the decrease should not exceed 20% for systolic and 15% for diastolic, and in the next 24 hours the pressure should become optimal for the subject. Diastolic pressure should not fall below 90 mmHg.

With a strong sharp imbalance of cerebral blood flow, the decrease in systolic pressure should be even slower: the upper one is no more than 15%, the lower one – 10% of the normal level.

To accelerate the initial decrease in blood pressure, the drug sodium nitroprusside (0.3-0.5 mcg/kg per 1 minute) is administered intravenously - it allows you to control the decrease in blood pressure.

Main action drugs (Clonidine and Clonidine) are also used intravenously in the form of a dropper in saline or as a bolus of 1-2 ml.

The antihypertensive drug Hypostat gives good results; it normalizes blood pressure within a few minutes.

Next, it is possible to switch to tablets - adrenergic blockers, calcium ion antagonists (Nifedipine - improve cerebral blood flow), ACE inhibitors (Enalapril, Captopril - optimize vascular tone), diuretics and other drugs.

To prevent new edema and reduce existing edema, Prednisolone and Dexamethasone are prescribed.

In the treatment of acute hypertensive encephalopathy in the presence of convulsive syndrome, Relanium is prescribed.

“Magnesia” and “Eufillin” will also have a calming and sedative effect. Due to disruption of lipid oxidation processes, antioxidants are prescribed:

droppers with Mexidol 400 mg;
"Ceraxon" 1000 mg;
"Cytoflavin" 10 ml intravenously.

It is very good to combine them with gluconeogenesis activators: mildronate 10-20 ml intravenously as a dropper.

Preventive drugs are Cavinton and Vinpocetine for 3 months. Hirudotherapy has a good effect.

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.