title: Does this patient have hypertensive encephalopathy?
abstract: A 63-year-old man was admitted to our hospital for further investigation and management of brain metastases. The patient was initially presented with a 4-day history of confusion. On the day of admission, the patient was confused, agitated, disorientated in place and time, and had visual disturbances. His blood pressure was repeatedly recorded high, with levels of systolic blood pressure between 170-210 mm Hg. A brain magnetic resonance imaging showed areas of high signal on T2 and fluid-attenuated inversion recovery images, located bilaterally in the white matter of the occipital regions and unilateral in the left frontal lobe, suggestive of posterior reversible encephalopathy syndrome. Aggressive treatment of hypertension resulted in complete resolution of the clinical and radiologic features of the syndrome.
authors.affiliation: Department of Internal Medicine, University Hospital of Ioannina, Ioannina, Greece.
authors.forename: Foteini
authors.initials: F
authors.lastname: Christopoulou
authors.affiliation: Department of Internal Medicine, University Hospital of Ioannina, Ioannina, Greece.
authors.forename: Evangelos C
authors.initials: EC
authors.lastname: Rizos
authors.affiliation: Radiology Department, Medical School, University Hospital of Ioannina, Ioannina, Greece.
authors.forename: Paraskevi
authors.initials: P
authors.lastname: Kosta
authors.affiliation: Radiology Department, Medical School, University Hospital of Ioannina, Ioannina, Greece.
authors.forename: Maria I
authors.initials: MI
authors.lastname: Argyropoulou
authors.affiliation: Department of Internal Medicine, University Hospital of Ioannina, Ioannina, Greece. Electronic address: egepi@cc.uoi.gr.
authors.forename: Moses
authors.initials: M
authors.lastname: Elisaf
mesh_terms: D017311:Amlodipine / Q000008:administration & dosage / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001713:Biphenyl Compounds / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging*; D002227:Carbazoles / Q000008:administration & dosage / Q000627:therapeutic use; D000077261:Carvedilol; D000072226:Computed Tomography Angiography; D003221:Confusion / Q000209:etiology; D003404:Creatinine / Q000097:blood; D004562:Electrocardiography; D005919:Glomerular Filtration Rate; D006212:Hallucinations / Q000209:etiology; D006261:Headache / Q000209:etiology; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage / Q000627:therapeutic use; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy*; D020343:Hypertensive Encephalopathy / Q000150:complications / Q000175:diagnosis*; D000077405:Irbesartan; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011412:Propanolamines / Q000008:administration & dosage / Q000627:therapeutic use; D012078:Renal Artery Obstruction / Q000097:blood / Q000139:chemically induced*; D013148:Spironolactone / Q000008:administration & dosage / Q000627:therapeutic use; D013777:Tetrazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D014463:Ultrasonography
chemical_list: D000959:Antihypertensive Agents; D001713:Biphenyl Compounds; D002227:Carbazoles; D011412:Propanolamines; D013777:Tetrazoles; D006852:Hydrochlorothiazide; D000077261:Carvedilol; D017311:Amlodipine; D013148:Spironolactone; D003404:Creatinine; D000077405:Irbesartan
keywords: Hypertension; PRES; confusion; encephalopathy