title: [Hypertensive encephalopathy: does not only occur at high blood pressure].
abstract: A 45-year-old man presented with severe hypertension, headache, cortical blindness, and a depressed level of consciousness. A second patient, a 33-year-old woman, was admitted with pre-eclampsia. She developed lethargy, headache, bilateral extensor plantar responses, and seizures. The third patient, a 62-year-old man, presented with acute renal failure due to necrotising vasculitis and glomerulonephritis. Five days after treatment with immunosuppressive drugs had been initiated, he developed headache, confusion, seizures, and cortical blindness. Hypertensive encephalopathy is characterised by headache, vomiting, disturbances in cognition and level of consciousness, visual abnormalities, and seizures. Imaging studies often demonstrate oedema of the white matter in the posterior parietal and occipital areas of the brain. This so-called reversible posterior leucoencephalopathy syndrome is well known in patients with severe hypertension, but it is also associated with immunosuppressive drug use and renal failure. It can be recognised by its fairly characteristic clinical features (different combinations of headache, vomiting, changes in cognition and level of consciousness, seizures, muscle weakness, and visual symptoms) and by its specific imaging findings. Treatment consists of reducing the blood pressure and reducing or discontinuing the use of immunosuppressive drugs. If the treatment is started promptly, symptoms and imaging abnormalities are usually reversible.
authors.affiliation: Afd. Neurologie, Universitair Medisch Centrum Utrecht, Postbus 85.500, 3508 GA Utrecht.
authors.forename: C A C
authors.initials: CA
authors.lastname: Wijman
authors.forename: I S
authors.initials: IS
authors.lastname: Beijer
authors.forename: G W
authors.initials: GW
authors.lastname: van Dijk
authors.forename: M J N C
authors.initials: MJ
authors.lastname: Wijman
authors.forename: J
authors.initials: J
authors.lastname: van Gijn
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications / Q000188:drug therapy; D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006974:Hypertension, Malignant / Q000150:complications; D020343:Hypertensive Encephalopathy / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011225:Pre-Eclampsia / Q000150:complications; D011247:Pregnancy
chemical_list: D000959:Antihypertensive Agents; D007166:Immunosuppressive Agents
vernacular_title: Hypertensieve encefalopathie: niet alleen bij zeer hoge bloeddrukwaarden.