Text Book Reading

Hypertensive Encephalopathy

By :
Fikri Fajrul Falah
DEPARTMENT OF NEUROLOGY
MEDICAL FACULTY OF GENERAL SOEDIRMAN UNIVERSITY
PROF. DR. MARGONO SOEKARDJO HOSPITAL
PURWOKERTO
2014

Background
Background

Hypertension is silent killer (Rahajeng & Tuminah,

2009).

HT that not controlled can make hypertensive crisis

(Emergence and Urgence) (Madhur, 2014;
Yogiantoro, 2009).

Emergence hypertension can damage brain (ex.

Hypertensive Encephalopathy) (Aggarwal et al, 2006)

Hypertensive encephalopathy acute cerebral event

due to marked elevation in arterial pressure
(Cuciureanu, 2007)

Content
Content
condition that marked by
elevation arterial pressure (systolic > 140 mmHg
or diastolic > 90 mmHg) (Madhur, 2014;
Yogiantoro, 2009)

Hypertension

Hypertension
Esential

consist of

hypertension unknown cause

Secondary

hypertension other cause

The seventh report of the joint national comitte on

prevention, detection, evaluation and treatment of
high blood pressure (JNC 7)

Classification

Systol

Diastol

Normal

< 120

< 80

Pre-hypertension

120-139

80-89

Hypertension gr I

140-159

90-99

Hypertension gr II

> 160

> 100

Blood pressure regulation

(Yogiantoro, 2009)

Hypertensive crisis
Condition marked with high acute elevation of
arterial blood pressure (>180/120 mmHg) (Madhur,
2014; Yogiantoro, 2009, Mallidi et al, 2013)
Emergence

hypertension

hypertensive crisis with organ damage

Urgency

hypertension

hypertensive crisis without organ damage but

potential to it.

Hypertensive Encephalopathy

Acute clinical syndrome that happen by sudden

elevation blood pressure that cant overcome by
autoregulation (Cuciureanu, 2007)

Is happen patien with history of hypertension

(Susanto, 2014).

This cause by every condition that make elevation

blood pressure (Susanto, 2014)

Pathogenesis
Overegulation Theory (Grisiewicz & Ruland, 2010).

Pathogenesis
Breakthrought Theory (Grisiewicz & Ruland, 2010).

Clinical Presentation
TRIAD HE
Emergence
Sign

hypertensive

of cerebral dysfunction

Resolution

after adequate treatment for HT

Neurological sign manifest with headeache, nausea

vomit, blur vision, confusion, decrease conciusness and
coma

(Cuciureanu, 2007; Heistad et al, 2003)

Diagnosa
Diagnosa

Anamnesa :

Neurological sign manifest with headeache, nausea

vomit, blur vision, confusion, decrease concousness
and coma
History of hypertention

Physical examination

Funduscopy (papilledema)

(Susanto, 2014)

Radiologic

CT scan and MRI white matter lesion sign of edema

(Susanto, 2014)

Deferential diagnoses

Stroke iskemik atau hemoragik

Stroke trombotik akut

Perdarahan intracranial

Encephalitis

Hipertensi intracranial

Lesi massa SSP

(Cuciureanu, 2007)

Treatment
Aim

to reduce of high arterial blood pressure under

constant monitoring and drug titration

Lowering arterial blood pressure 25% in 1-2 hour and

diastolic 100-110 mmHg

Use rapid acting intravenous antihypertensive agent

(labetalol, sodium nitroprusid)

Labetalol 20 mg bolus then 20-80 mg iv each 10

minutes until goal, max 200 mg

Sodium Nitroprusid 0,3-0,5 mcg/kg/min IV,

adjusting the infusion until 1-6 mcg/kg/min

(Cuciureanu, 2007)

Prognosis

If blood pressure not in treatment, it can make coma

and then die, but if the high blood pressure get
adecuate treatment the prognosis is good base on the
severe of symptomt

(Susanto, 2014)