Hypertensive encephalopathy

This is a result of hyperperfusion of the brain when the upper limit of cerebral autoregulation has been exceeded. Patient symptoms commonly progress over a period of 2 to 3 days, as opposed to an intracranial hemorrhage which generally has a more abrupt onset. The therapeutic goal is a reduction in mean arterial pressure by 20

to 25 per cent or to 110 to 120 mmHg over a period of 2 to 3 h (CalhGun.andOparjJ 1990; Tietje.n.e.t..a/; 1996). The drug of choice is sodium nitroprusside by constant intravenous infusion. An alternative is labetalol by small pulse doses or constant intravenous infusion. If the patient does not exhibit clinical improvement as the blood pressure is reduced, other diagnoses should be considered. Normally, patients with hypertensive encephalopathy improve in direct proportion to the control achieved in their blood pressure.

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