What is hypertensive encephalopathy? Causes, symptoms, treatment

Brain ischemia, strokes, heart attacks and encephalopathies are considered the most serious ailments. Often they end in a fatal outcome. Among a large number of pathologies of the brain, special attention is paid to encephalopathy. This is a vast group of diseases. They are characterized by dystrophic changes in the brain tissues and lead to violations of its functions. The etiology of ailments varies, and the clinical picture varies. One of the most common forms is hypertensive encephalopathy. Symptoms and methods of treatment of pathology will be discussed in this article.

Changes in the brain against a background of hypertension

Even a one-time increase in blood pressure negatively affects the state of the nervous tissue. All small vessels are gradually involved in the pathological reaction, but the target organs suffer the most. They can include kidneys, heart and brain.

During a moderate increase in blood pressure, the protective mechanism of constriction of the blood vessels is activated, which prevents them from rupturing. With stable arterial hypertension, the muscular layer of artery walls gradually thickens, hypertrophies. The lumen of the vessels narrows, which leads to a permanent deficiency of oxygen in the body. A hypertensive form of ischemia develops, which is otherwise called discirculatory encephalopathy.

A rapid and pronounced increase in blood pressure provokes damage to the inner shell of the vessels. A strong spasm of arterioles is replaced by paralysis. At the same time, passive stretching of the walls of small vessels with blood occurs. This condition is called hypertensive encephalopathy. It is characterized by a phased development. Therefore, if you notice symptoms of the disease in a timely manner and consult a doctor, you can avoid negative consequences.

Hypertensive encephalopathy - what is it?

This is a pathological condition that develops in the brain tissues as a result of a persistent uncontrolled increase in blood pressure. What parameters are considered a deviation from the norm? Arterial hypertension is an increase in systolic pressure above 140 mm Hg. And diastolic - more than 90 mm Hg. Art. In 1928, scientists Oppenheimer and Fishberg described the symptoms and pathogenesis of such a disease as hypertensive encephalopathy (ICD-10 code - I-67.4).

Causes of pathology

To understand the etiology of the disease, it is necessary to understand the mechanism of its development. One of the complications of hypertension is hypertensive encephalopathy. According to the ICD-10, this disease belongs to the pathology of the circulatory system. All the causes of sharp jumps in blood pressure can be conditionally divided into congenital and acquired. Doctors say that the risk of hypertension increases several times, if close relatives of the patient suffered from this disorder. However, the hereditary form of the disease is diagnosed mainly among young people. In the elderly, the primary role in the development of hypertension is played by factors related to the lifestyle of a person. These include the following:

• Pernicious habits;
• High cholesterol;
• Intoxication of the body;
• Drug overdose;
• Some diseases.

It should be noted that constantly high blood pressure rarely contributes to the development of the disease. The brain vessels gradually adapt to this state. Sharp pressure jumps are considered the most dangerous. They can provoke a vasospasm and ischemia.

Clinical manifestations

There are two forms of the disease. Acute hypertensive encephalopathy is characterized by reversible disorders. They pass after the cupping of the edema and the restoration of blood circulation. Symptoms of chronic encephalopathy at the initial stage are poorly expressed, and are detected only during medical examination. Progression of pathology is accompanied by motor, sensory and cognitive disorders. More details about each variant of the course of the disease are described below.

Acute form of the disease

Acute hypertensive encephalopathy develops during the current crisis, and blood pressure can vary. In patients with experience, a pressure increase up to 180-190 mm Hg is considered critical. Art. In persons susceptible to hypotension, this threshold is slightly lower and is 140/90 mm Hg. Art.

Among the main symptoms of the acute form of the disease are the following:

• Severe headache, localized in the occipital part;
• nausea, vomiting;
• Sudden deterioration of vision;
• Convulsive seizures;
• Unexpressed peripheral paresis;
• Stun status.

If you have these symptoms, you should immediately seek medical help.

Chronic form of the disease

Chronic hypertensive encephalopathy develops gradually. Each stage is characterized by a specific clinical picture.

At the first stage, there are primary signs of the disease, which can be confused with manifestations of other ailments. For example, severe headaches are written off for stress, trying to stop them with usual analgesics. Also, patients complain of distraction of attention, ringing in the ears, weakness in the entire body. Such symptoms are rarely noticed, especially in old age. As a result, hypertensive encephalopathy passes to the next stage of development.

In the second stage, the symptoms remain the same, but they become more acute and acquire a more pronounced character. They are joined by signs associated with the psycho-emotional mood of a person (apathy, lethargy, sudden changes in mood). Hypertensive encephalopathy of the 2nd degree affects human performance. He very quickly gets tired, lost motivation, the ability to organize their own activities. Sometimes accompanying behavioral disorders serve as an occasion for consultation with a psychiatrist.

At the third stage, the existing neurological disorders are aggravated. With focal lesions of the brain, epileptic seizures are not ruled out . In elderly patients, hypertensive encephalopathy often provokes the development of Parkinsonian syndrome.

Medical Examination

Diagnosis of the disease is carried out on the basis of patient complaints, history, general symptoms. The results of previous surveys are also used. The difficulty of diagnosis can be that the manifestations of encephalopathy are similar to the clinical picture of other pathologies. Among the latter can be attributed to a brain tumor, stroke. Therefore, before the appointment of therapy, the patient must undergo a series of tests:

• Analysis of blood and urine;
• MRI, CT of the brain;
• Echocardiography;
• Electroencephalography.

Additionally, it may be necessary to consult outside specialists (cardiologist, therapist, nephrologist, endocrinologist).

Principles of treatment

The acute form of the disease requires immediate hospitalization. The patient is identified in the intensive care unit, where all vital signs are constantly monitored.

What medications are prescribed for the diagnosis of "hypertensive encephalopathy"? Treatment begins with a decrease in blood pressure. The following preparations are used for this:

• "Diazoxide".
• "Hydralazine."
• "Nitroprusside."
• "Nitroglycerine".

The most effective is "Diazoxide". Under its influence, the pressure values are equalized within five minutes, and the effect of taking the medication remains from 6 to 18 hours. This drug does not affect the patient's consciousness and does not cause drowsiness, which is a significant advantage. However, its use can provoke the development of reflex tachycardia, so it is contraindicated in patients with ischemia of the heart.

Ganglia-blockers are also used to normalize blood pressure in hypertensive encephalopathy. This group of medicines includes the following drugs:

• "Labetalol."
• "Pentolinium."
• "Fentolamine."
• "Trimetafan".

The listed medicines are characterized by a quick action, but at the same time they have a lot of side effects. In pregnancy, their use is strictly prohibited, since there is a probability of miscarriage.

Chronic form of the disease, as well as acute, according to the ICD-10 has the code I-67.4. Hypertensive encephalopathy of the progressive type in the initial stages has similar symptoms with it, but the therapy is somewhat different. In the chronic form of the disease, simultaneously with antihypertensive drugs, metabolic agents, vitamins, nootropics are prescribed. Most often use "Trental", aspirin preparations, "Dipiridamol". With gross behavioral disorders, sedatives and antidepressants are used. Competent and timely therapy helps to reduce the rate of progression of such a disease as hypertensive encephalopathy.

Is the disability group?

Such a natural question arises in many relatives of patients, when the clinical picture of the disease unfolds in full force. The general condition of the patient worsens, the progress of the pathological process becomes obvious, and this deprives the person of his former abilities and a full-time life. Disability with encephalopathy is possible, especially at the second and third degree. It is assigned by the decision of the medical commission. Assessment of the patient's performance is not only based on his history, but also on the results of the examination and the analysis of efficiency.

Preventive measures

Hypertensive encephalopathy is a serious disorder affecting the entire body. It can be confidently asserted that this disease is a mandatory complication of hypertension in the absence of quality treatment. Observance of simple rules of prevention helps prevent its appearance.

First of all, it is necessary to monitor blood pressure. Most often, problems with the pressure of modern man appear due to his way of life. Incorrect nutrition, constant stress, inactivity, bad habits - these factors sooner or later lead to ailment. Therefore, the employment of affordable sports, the right diet and a positive attitude will help to keep the vessels in a healthy state for a long time.