Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-15T12:06:07.722Z Has data issue: false hasContentIssue false
  • English
  • Français

Hyperperfusion Syndromes: Insight into the Pathophysiology and Treatment of Hypertensive Encephalopathy

Published online by Cambridge University Press:  07 November 2014

Craig J. Gardner  and
Kiwon Lee
Get access Rights & Permissions [Opens in a new window]

Abstract

Hypertensive encephalopathy is one of the manifestations of a hypertensive crisis. It is not the absolute value of the blood pressure that causes the encephalopathy, rather the presence of an abrupt rise in pressure. In terms of clinical and radiographic findings, there are many similarities among a group of entities, including hypertensive encephalopathy, eclampsia, and immunosuppressant neurotoxicity. Hyperperfusion syndromes may represent these clinical disease states that may share the same pathophysiology. Magnetic resonance imaging fluid attenuated inversion recovery sequences have recognized the prominent cortical involvement of the disease that had been previously missed on computed tomography. Studies have found cortical involvement in 94% of their patients, particularly in mild cases. Animal models demonstrate endothelial damage and enhanced pinocytosis in the cortex as reasons why edema may begin in that region of the brain. Patients diagnosed with hypertensive encephalopathy should be diagnosed and treated promptly in order to avoid further neurological complications. The mean arterial pressure should be lowered by 20% to 25% within the first hour of patient presentation, followed by further gradual reduction in blood pressure over the following 24 hours. Hypertensive emergency in acute ischemic stroke should be managed with more caution. According to the 2003 American Stroke Association treatment guidelines, for patients with ischemic stroke not eligible for thrombolytic therapy, target blood pressures are a diastolic blood pressure <120 mmHg and systolic blood pressure <220 mmHg. The systolic pressure must be <185 mmHg and diastolic pressure <110 mmHg at all times if eligible for thrombolytic therapy.

Type
Review Articles
Information
CNS Spectrums , Volume 12 , Issue 1 , January 2007 , pp. 35 - 42
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Chobanian, AV, Bakris, GL, Black, HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–1252.CrossRefGoogle ScholarPubMed
2.Varon, J, Marik, PE. The diagnosis and management of hypertensive crises. Chest. 2000;118:214–227.CrossRefGoogle ScholarPubMed
3.Lip, GY, Beevers, M, Beevers, DG. Complications and survival of 315 patients with malignant-phase hypertension. J Hypertens. 1995;13:915–924.CrossRefGoogle ScholarPubMed
4.Schwartz, RB. A reversible posterior leukoencephalopathy syndrome (letter). N Engl J Med. 1996;334:1734.Google Scholar
5.Schwartz, RB. Hyperperfusion encephalopathies: hypertensive encephalopathy and related conditions. Neurologist. 2002;8:22–34.CrossRefGoogle ScholarPubMed
6.Feske, SK. Hyperperfusion syndromes. Continuum: lifelong learning in neurology. 2005;11:91–113.Google Scholar
7.Hashimoto, H, Kuriyama, Y, Naritomi, H, Sawada, T. Serial assessments of middle cerebral artery flow velocity with transcranial Doppler sonography in the recovery stage of eclampsia. A case report. Angiology. 1997;48:355–358.CrossRefGoogle ScholarPubMed
8.Vliegen, JH, Muskens, E, Keunen, RW, Smith, SJ, Godfried, WH, Gerretsen, G. Abnormal cerebral hemodynamics in pregnancy-related hypertensive encephalopathy. Eur J Obstet Gynecol Reprod Biol. 1993;49:198–200.CrossRefGoogle ScholarPubMed
9.Johansson, BB. Regional cerbral blood flow in acute experimental hypertension. Acta Neurol Scand. 1974;50:366–372.CrossRefGoogle Scholar
10.Nag, S, Robertson, DM, Dinsdale, HB. Cerebral cortical changes in acute experimental hypertension: an ultrastructural study. Lab Invest. 1977;36:150–161.Google ScholarPubMed
11.Fredriksson, K, Kalimo, H, Westergren, I, Kahrstrom, J, Johansson, BB. Blood-brain barrier leakage and brain edema in stroke-prone spontaneously hypertensive rats. Effect of chronic sympathectomy and low protein/high salt diet. Acta Neuropathol (Berl). 1987;74:259–268.CrossRefGoogle ScholarPubMed
12.Hinchey, J, Chaves, C, Appignani, B, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996;334:494–500.CrossRefGoogle ScholarPubMed
13.Casey, SO, Sampio, RC, Michel, E, Truwit, CL. Posterior reversible encephalopathy syndrome: utility of fluid-attenuated inversion recovery MR imaging in the detection of cortical and subcortical lesions. AJNR Am J Neuroradiol. 2000;21:1199–1206.Google ScholarPubMed
14.Paulson, OB, Strandgaard, S, Edvinsson, L. Cerebral autoregulation. Cerebrovasc Brain Metab Rev. 1990;2:161–192.Google ScholarPubMed
15.Vavilala, MS, Lee, LA, Lam, AM. Cerebral blood flow and vascular physiology. Anesthesiol Clin North America. 2002;20:247–264.CrossRefGoogle ScholarPubMed
16.MacKenzie, ET, Strandgaard, S, Graham, DI, Jones, JV, Harper, AM, Farrar, JK. Effects of acutely induced hypertension in cats on pial arteriolar caliber, local cerebral blood flow, and the blood-brain barrier. Circ Res. 1976;39:33–41.CrossRefGoogle ScholarPubMed
17.Shinhoj, E, Strandgaard, S. Pathogenesis of hypertensive encephalopathy. Lancet. 1973;1:461–462.CrossRefGoogle Scholar
18.Strandgaard, S, Olesen, J, Skinhoj, E, LAssen, NA. Autoregulation of brain circulation in severe arterial hypertension. Br Med J. 1973;1:507–510.CrossRefGoogle ScholarPubMed
19.Immink, RV, van den Born, BH, van Montfrans, GA, et al. Impaired cerebral autoregulation in patients with malignant hypertension. Circulation. 2004;110: 2241–2245.CrossRefGoogle ScholarPubMed
20.Oppenheimer, BS, Fishberg, AM. Hypertensive encephalopathy. Arch Intern Med. 1928;41:264–277.CrossRefGoogle Scholar
21.Byrom, FB, Lund, MD. The pathogenesis of hypertensive encephalopathy and its relation to the malignant phase of hypertension. Lancet. 1954;2:201–211.CrossRefGoogle Scholar
22.Weidauer, S, Gaa, J, Sitzer, M, Hefner, R, Lanfermann, H, Zanella, FE. Posterior encephalopathy with vasospasm: MRI and angiography. Neuroradiology. 2003;45:869–876.CrossRefGoogle ScholarPubMed
23.Giese, J. Acute hypertensive vascular disease 2. Studies on vascular reaction patterns and permeabilty changes by means of vital microscopy and colloidal tracer technique. Acta Pathol Microbiol Scand. 1964;62:497–515.CrossRefGoogle Scholar
24.Byrom, FB. Hypertensive encephalopathy. Lancet. 1973;1:766–767.Google ScholarPubMed
25.Strandgaard, S, Jones, JV, McKenzie, ET, Graham, DI, Farrar, JK. The sausage-string pattern in the pial vessels in acute, angiotensin-induced hypertension–vasospasm or vasodilatation? Acta Med Scand Suppl. 1976;602:9–12.Google ScholarPubMed
26.Auer, L. The sausage-string phenomenon in acutely induced hypertension–arguments against the vasospasm theory in the pathogenesis of acute hypertensive encephalopathy. Eur Neurol. 1978;17:166–173.CrossRefGoogle ScholarPubMed
27.Beausang-Linder, M, Bill, A. Cerebral circulation in acute arterial hypertension–protective effects of sympathetic nervous activity. Acta Physiol Scand. 1981;111:193–199.CrossRefGoogle ScholarPubMed
28.Sadoshima, S, Heistad, D. Sympathetic nerves protect the blood-brain barrier in stroke-prone spontaneously hypertensive rats. Hypertension. 1982;4:904–907.CrossRefGoogle ScholarPubMed
29.Kaskel, FJ, Deverajan, P, Birzgalis, A, Moore, LC. Inhibition of myogenic aurotegulation in cyclosporine nephrotoxicity in the rat. Renal Physiol Biochem. 1989;12:250–259.Google ScholarPubMed
30.Schwartz, RB, Feske, SK, Polak, JF, et al. Preeclampsia-eclampsia: clinical and neuroradiographic correlates and insights into the pathogenesis of hypertensive encephalopathy. Radiology. 2000:217:371–376.CrossRefGoogle ScholarPubMed
31.Raroque, HG, Orrison, WW, Rosenberg, GA. Neurologic involvement in toxemia of pregnancy: reversible MRI lesions. Neurology. 1990;40:167–169.CrossRefGoogle ScholarPubMed
32.Rovang, R, Zawada, ET, Santella, RN, Jaqua, RA, Boice, JL, Welter, RL. Cerebral vasculitis associated with acute post-streptococcal glomerulonephritis. Am J Nephrol. 1997;17:89–92.CrossRefGoogle ScholarPubMed
33.Hodson, AK, Doughty, RA, Norman, ME. Acute encephalopathy,m streptococcal infection, and cryoglobulinemia. Arch Neurol. 1978;35:43–44.CrossRefGoogle Scholar
34.Angles-Cano, E. Endothelial damage and hypofibrinolysis in systemic lupus erythematosus. Thromb Haemost. 1989;61:322.Google ScholarPubMed
35.Schwartz, RB. Cyclosporine neurotoxicity and its relationship to hypertensive encephalopathy: CT and MR findings in 16 cases. AJR Am J Roentgenol. 1995;165:627–631.CrossRefGoogle Scholar
36.Lavigne, CM, Shrier, DA, Ketkar, M, Powers, JM. Tacrolimus leukoencephalopathy: a neuropathologic confirmation. Neurology. 2004;63:1132–1133.CrossRefGoogle ScholarPubMed
37.Ito, Y, Arahata, Y, Goto, Y, et al. Cisplatin neurotoxicity presenting as reversible posterior leukoencephalopathy syndrome. AJNR Am J Neuroradiol. 1998;19:415–417.Google ScholarPubMed
38.Ironside, JW, Pickard, JD. Raised intracranial pressure, oedema and hydrocephalus. In: Graham, DI, Lantos, PL, eds. Greenfield's Neuropathology. 7th ed. London, England: Arnold; 2002:194–230.Google Scholar
39.Kalimo, H, Fredriksson, K, Nordborg, C, Auer, RN, Olsson, Y, Johansson, B. The spread of brain oedema in hypertensive brain injury. Med Biol. 1986;64:133–137.Google ScholarPubMed
40.Plum, F, Posner, JB, Alvord, EC. Edema and necrosis in experimental cerebral infarction. Arch Neurol. 1963;9:563–570.CrossRefGoogle Scholar
41.Nag, S, Robertson, DM, Dinsdale, HB. Quantitative estimate of pinocytosis in experimental acute hypertension. Acta Neuropathol (Berl). 1979;46:107–116.CrossRefGoogle ScholarPubMed
42.Adachi, M, Feigin, I. Cerebral oedema and the water content of normal white matter. J Neurol Neurosurg Psychiatry. 1966;29:446–450.CrossRefGoogle ScholarPubMed
43.Dinsdale, HB. Hypertensive encephalopathy. Stroke. 1982;13:717–719.CrossRefGoogle ScholarPubMed
44.Schwartz, RB, Mulkern, RV, Gudbjartsson, H, Jolesz, F. Diffusion-weighted MR imaging in hypertensive encephalopathy: clues to pathogenesis. AJNR Am J Neuroradiol. 1998;19:859–862.Google ScholarPubMed
45.Covarrubias, DJ, Luetmer, PH, Campeau, NG. Posterior Reversible Encephalopathy Syndrome: Prognostic Utility of Quantitative Diffusion-Weighted MR Images. AJNR Am J Neuroradiol. 2002;23:1038–1048.Google ScholarPubMed
46.Adams, HP, Adams, RJ, Brott, T, et al. Guidelines for the early management of patients with ischemic stroke: a scientific statement from the Stroke Council of the American Stroke Association. Stroke. 2003;34:1056–1083.CrossRefGoogle ScholarPubMed
47.Testa, LD, Tobias, JD. Pharmacologic drugs for controlled hypotension. J Clin Anesth. 1995;7:326–337.CrossRefGoogle ScholarPubMed