Hypertensive encephalopathy as a complication of hyperdynamic therapy for vasospasm: report of two cases.
OBJECTIVE
After developing subarachnoid hemorrhage, patients may deteriorate from a variety of well-known causes, including rebleeding, hydrocephalus, and vasospasm. Many patients now undergo empirical hyperdynamic vasospasm therapy with hypervolemia, induced hypertension, and nimodipine.


METHODS
We report two cases of iatrogenic hypertensive encephalopathy occurring during hyperdynamic therapy for cerebral vasospasm after subarachnoid hemorrhage. Hypertensive encephalopathy is a syndrome of rapidly evolving generalized or focal cerebral symptoms occurring in the setting of severe hypertension, which is reversible with antihypertensive therapy.


METHODS
The syndrome can be diagnosed in the appropriate clinical setting with computed tomographic or magnetic resonance imaging that demonstrates characteristic findings. In both cases, decreasing the blood pressure resulted in neurological improvement.


CONCLUSIONS
In the setting of induced hypertensive/hypervolemic therapy for vasospasm, hypertensive encephalopathy should be considered as a potentially reversible cause of delayed neurological decline.
Amin-Hanjani
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Neurosurgical Service, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
Schwartz
R B
RB
Sathi
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Stieg
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PE
D000368:Aged; D001794:Blood Pressure / Q000187:drug effects*; D001927:Brain Diseases / Q000139:chemically induced*; D004280:Dobutamine / Q000009:adverse effects* / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D006973:Hypertension / Q000139:chemically induced*; D007049:Iatrogenic Disease; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
D004280:Dobutamine