title: Convulsions and hypertension in children: differentiating cause from effect.
abstract: OBJECTIVE
  To determine if the magnitude of blood pressure (BP) increase could differentiate convulsion caused by a hypertensive crisis from a primary convulsive disorder, which itself increases BP.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  Admission to a pediatric intensive care unit (ICU) within a tertiary care center.
  
  
  METHODS
  All children with hypertensive crisis admitted to the pediatric ICU from 1976 to 1990 were studied. Thirty-eight episodes occurred in 36 patients. The charts of children admitted for status epilepticus from 1976 to 1986 were also reviewed. One hundred and fifty-three episodes occurred in 145 patients.
  
  
  RESULTS
  BP values at entry to the pediatric ICU in patients with hypertensive crisis were compared with the highest BP values obtained within an hour after cessation of convulsion in 120 patients admitted for status epilepticus. The Z scores for BP, adjusted for age and sex, were compared. The BP values for children in hypertensive crisis with or without convulsions were by far greater than the BP values observed in patients in status epilepticus (p < .0001). For a patient in the postictal phase, a BP > or = 4.0 SD above the mean for age and sex predicted with 78% probability the presence of a hypertensive crisis requiring emergency treatment. If the BP was < 4 SD below the mean, the possibility of a hypertensive crisis was excluded (negative-predictive value 100%).
  
  
  CONCLUSIONS
  Children with hypertensive crisis, as well as children with status epilepticus, can present with a high BP. In a postictal patient, the magnitude of BP increase is a useful clinical parameter to exclude a hypertensive crisis that requires specific treatment of the BP.
authors.affiliation: Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Canada.
authors.forename: F
authors.initials: F
authors.lastname: Proulx
authors.forename: J
authors.initials: J
authors.lastname: Lacroix
authors.forename: C A
authors.initials: CA
authors.lastname: Farrell
authors.forename: M
authors.initials: M
authors.lastname: Gauthier
mesh_terms: D000293:Adolescent; D001794:Blood Pressure; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000209:etiology; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D012189:Retrospective Studies; D012640:Seizures / Q000150:complications* / Q000209:etiology; D013226:Status Epilepticus / Q000150:complications