title: [Unfavorable outcome of aggressive lowering of high blood pressure. Case report].
abstract: Cerebral autoregulation is essential in the maintenance of cerebral blood flow. Due to this autoregulation, cerebral perfusion is constant in healthy subjects if blood pressure values are between 50-150 mmHg. In hypertensive patients the curve is right-shifted towards higher blood pressure values (pathological autoregulation). Aggressive blood pressure reduction can lead to severe ischaemia. The authors report the history of a 73-year-old man with the background history of widespread atherosclerotic disease. The patient complained about headache and dizziness and was found to have high blood pressure (160/100 mmHg) and increased blood glucose (14.8 mmol/l). Prior to his admission an aggressive blood pressure and blood sugar reduction was carried out and, within a short period of time he became unconscious and was transferred to the department of the authors with the possible diagnosis of brainstem stroke. On admission the patient was unresponsive, comatose with brainstem symptoms. Urgent brain computed tomography failed to show any acute alterations. However, repeat CT scan revealed extensive bilateral space occupying ischemic changes involving in territories of both internal carotid arteries with consequent brainstem compression. Computed tomography angiography confirmed bilateral internal carotid artery occlusion. The authors conclude that intensive blood pressure reduction result in ischemic lesions via hypoperfusion especially in patients with widespread atherosclerotic disease and significant carotid vessel pathology.
authors.affiliation: Pécsi Tudományegyetem, Általános Orvostudományi Kar Neurológiai Klinika Pécs.
authors.forename: Diána
authors.initials: D
authors.lastname: Kuperczkó
authors.affiliation: Pécsi Tudományegyetem, Általános Orvostudományi Kar Neurológiai Klinika Pécs.
authors.forename: Péter
authors.initials: P
authors.lastname: Csécsei
authors.affiliation: Pécsi Diagnosztikai Központ Pécs.
authors.forename: Hedvig
authors.initials: H
authors.lastname: Komáromy
authors.affiliation: Pécsi Tudományegyetem, Általános Orvostudományi Kar Neurológiai Klinika Pécs.
authors.forename: László
authors.initials: L
authors.lastname: Szapáry
authors.affiliation: Pécsi Tudományegyetem, Általános Orvostudományi Kar Neurológiai Klinika Pécs Szigetvári Kórház Neurológiai Osztály Szigetvár Szent István ltp. 7. 7900.
authors.forename: Gergely
authors.initials: G
authors.lastname: Fehér
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D050197:Atherosclerosis / Q000150:complications; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D002545:Brain Ischemia / Q000139:chemically induced* / Q000000981:diagnostic imaging; D001933:Brain Stem / Q000000981:diagnostic imaging / Q000473:pathology*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D003128:Coma / Q000139:chemically induced* / Q000503:physiopathology; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D014057:Tomography, X-Ray Computed
chemical_list: D000959:Antihypertensive Agents; D015415:Biomarkers; D001786:Blood Glucose; D007004:Hypoglycemic Agents
keywords: acute hypertensive encephalopathy crisis; aggressive blood pressure lowering; akut hipertenzív encephalopathiás krízis; bilateral carotid artery occlusion; blood sugar management; diabetes; generalizált érbetegség; kétoldali arteria carotis okklúzió; vércukorrendezés; vérnyomáscsökkentés; widespread atherosclerotic disease