Cerebral ischemia, strokes, heart attacks and encephalopathies are considered the most serious illnesses. Often they end in death. Among a large number of brain pathologies, encephalopathies deserve special attention. This is a broad group of diseases. They are characterized by dystrophic changes in the brain tissues and lead to violations of its functions. The etiology of ailments is different, and the clinical picture also varies. One of the most common forms is hypertensive encephalopathy. Symptoms and treatments for pathology will be discussed in this article.
Changes in the brain due to hypertension
Even a one-time increase in blood pressure negatively affects the state of the nervous tissue. All small vessels are gradually involved in the pathological reaction, but the target organs suffer the most. These include the kidneys, heart and brain.
During a moderate increase in blood pressure, the protective mechanism of blood vessel constriction is activated, which prevents them from bursting. With stable arterial hypertensionthe muscular layer of the walls of the arteries gradually thickens, hypertrophies. The lumen of the vessels narrows, which leads to a constant oxygen deficiency in the body. A hypertensive form of ischemia develops, which is otherwise called discirculatory encephalopathy.
A rapid and pronounced increase in blood pressure provokes damage to the inner lining of blood vessels. A strong spasm of arterioles is replaced by paralysis. At the same time, passive stretching of the walls of small blood vessels occurs. This condition is called hypertensive encephalopathy. It is characterized by gradual development. Therefore, if you notice the symptoms of the disease in a timely manner and consult a doctor, you can avoid negative consequences.
Hypertensive encephalopathy - what is it?
This is a pathological condition that develops in the tissues of the brain as a result of a persistent uncontrolled increase in blood pressure. What parameters are considered a deviation from the norm? Arterial hypertension is considered to be an increase in systolic pressure in excess of 140 mm Hg. Art., and diastolic - more than 90 mm Hg. Art. In 1928, scientists Oppenheimer and Fishberg described the symptoms and pathogenesis of such a disease as hypertensive encephalopathy (ICD-10 code - I-67.4).
Causes of pathology
To understand the etiology of the disease, it is necessary to understand the mechanism of its development. One of the complications of high blood pressure is hypertensive encephalopathy. According to ICD-10, this disease refers to pathologies of the circulatory system. All causes of sudden jumps in blood pressure can be divided into congenital and acquired. Physicians note that the riskthe occurrence of hypertension increases several times if close relatives of the patient suffered from this disorder. However, the hereditary form of the disease is diagnosed mainly among young people. In old age, lifestyle factors play a primary role in the development of hypertension. These include the following:
- bad habits;
- high cholesterol;
- intoxication of the body;
- drug overdose;
- some diseases.
It should be noted that constantly high blood pressure rarely contributes to the development of the disease. The vessels of the brain gradually adapt to this state. Sudden pressure surges are considered the most dangerous. They can provoke vasospasm and ischemia.
Clinical manifestations
There are two forms of the course of the disease. Acute hypertensive encephalopathy is characterized by reversible disorders. They disappear after the relief of edema and restoration of blood circulation. Symptoms of chronic encephalopathy at the initial stage are mild, and are detected only during a medical examination. The progression of the pathology is accompanied by motor, sensory and cognitive disorders. More details about each variant of the course of the disease are described below.
Acute disease
Acute hypertensive encephalopathy develops during the current crisis, and BP values may vary. In patients with critical experiencean increase in pressure to the level of 180-190 mm Hg is considered. Art. In persons prone to hypotension, this threshold is slightly lower and is 140/90 mm Hg. st.
Among the main symptoms of the acute form of the disease are the following:
- severe headache localized in the back of the head;
- nausea, vomiting;
- sudden deterioration of vision;
- convulsive seizures;
- unexpressed peripheral paresis;
- stun state.
If you experience any of the following symptoms, seek immediate medical attention.
Chronic disease
Chronic hypertensive encephalopathy develops gradually. Each stage is characterized by a specific clinical picture.
At the first stage, primary signs of the disease appear, which can be confused with manifestations of other ailments. For example, severe headaches are attributed to stress, trying to stop them with conventional analgesics. Also, patients complain of absent-mindedness, ringing in the ears, weakness throughout the body. Such symptoms are rarely noticed, especially in old age. As a result, hypertensive encephalopathy moves to the next stage of development.
In the second stage, the symptoms remain the same, but worsen and become more pronounced. They are joined by signs associated with the psycho-emotional mood of a person (apathy, lethargy, sudden mood changes). Hypertensive encephalopathy of the 2nd degree affects the performance of a person. Hegets tired very quickly, motivation disappears, the ability to organize one's own activities. Sometimes comorbid behavioral disorders warrant a consultation with a psychiatrist.
At the third stage, the existing neurological disorders are aggravated. With focal brain damage, epileptic seizures are not excluded. In elderly patients, hypertensive encephalopathy often provokes the development of parkinsonism.
Medical examination
Diagnosis of the disease is carried out on the basis of the patient's complaints, anamnesis data, general symptoms. The results of previous surveys are also used. The difficulty of diagnosis may lie in the fact that the manifestations of encephalopathy are similar to the clinical picture of other pathologies. The latter include a brain tumor, a stroke. Therefore, before prescribing therapy, the patient must undergo a series of tests:
- blood and urine test;
- MRI, CT scan of the brain;
- echocardiography;
- electroencephalography.
Additionally, consultation with third-party specialists (cardiologist, internist, nephrologist, endocrinologist) may be required.
Principles of treatment
The acute form of the disease requires immediate hospitalization. The patient is admitted to the intensive care unit, where all vital signs are continuously monitored.
What medications are prescribed for the diagnosis of "hypertensive encephalopathy"? Treatment starts withlowering blood pressure. To do this, use the following drugs:
- "Diazoxide".
- Hydralazine.
- Nitroprusside.
- "Nitroglycerin".
Diazoxide is the most efficient. Under its influence, pressure indicators level off within five minutes, and the effect of taking the medicine lasts from 6 to 18 hours. This drug does not affect the patient's consciousness and does not cause drowsiness, which is a significant advantage. However, its use can provoke the development of reflex tachycardia, so it is contraindicated in patients with cardiac ischemia.
Ganglioblockers are also used to normalize blood pressure in hypertensive encephalopathy. This group of drugs includes the following drugs:
- Labetalol.
- Pentolinium.
- "Fentolamine".
- "Trimetafan".
The listed drugs are characterized by rapid action, but at the same time they have many side effects. During pregnancy, their use is strictly prohibited, since there is a possibility of miscarriage.
The chronic form of the disease, like the acute one, according to ICD-10 has the code I-67.4. Hypertensive encephalopathy of the progressive type in the initial stages has similar symptoms with it, but the therapy is somewhat different. In the chronic form of the disease, along with antihypertensive drugs, metabolic agents, vitamins, and nootropics are prescribed. Most often they use Trental, aspirin preparations, Dipyridamole. With roughbehavioral disorders use sedatives and antidepressants. Competent and timely therapy helps to reduce the rate of progression of a disease such as hypertensive encephalopathy.
Is there a disability group?
Such a legitimate question arises in many relatives of patients when the clinical picture of the disease unfolds in full force. The general condition of the patient worsens, the progress of the pathological process becomes obvious, and this deprives the person of his former opportunities and full-fledged life. Disability with encephalopathy is possible, especially in the second and third degrees. It is assigned by the decision of the medical commission. Evaluation of the patient's performance is carried out not only according to his anamnesis, but also according to the results of the examination and analysis of performance.
Prevention measures
Hypertensive encephalopathy is a serious disorder affecting the entire body. It is safe to say that this disease is a mandatory complication of arterial hypertension in the absence of high-quality treatment. Compliance with simple rules of prevention can prevent its occurrence.
First of all, it is necessary to control blood pressure indicators. Most often, problems with pressure in a modern person appear as a result of his lifestyle. Improper nutrition, constant stress, physical inactivity, bad habits - these factors sooner or later lead to illness. Therefore, classes are feasiblesports, the right diet and a positive attitude will help keep blood vessels in a he althy state for a long time.
