Hypertensive Encephalopathy

Hypertensive encephalopathy is acute in onset and presents with headache, confusion and drowsiness. With expedient treatment it is reversible, but, without appropriate intervention, it can progress to:

• Seizures
• Focal neurological deficits
• Coma
• Death

In the early stages, CT scan is usually normal, but in the later stages haemorrhages may be present.

CT must be ordered prior to treatment to differentiate from intracranial haemorrhage. BP reduction in this instance could be detrimental

Expedient and controlled reduction of blood pressure is essential. The agent of choice is Labetalol as it provides a steady consistent drop in blood pressure without compromising CBF. An initial reduction of MAP of approximately 25% over an hour should be the aim, followed by further controlled MAP reduction over the ensuing 24 hours.

nicardipine can be considered in those intolerant of Beta blockers.

Learning Bite

Labetalol is the agent of choice in hypertensive encephalopathy.