The signs and symptoms of hypertensive encephalopathy result from a rapid increase in diastolic blood pressure to more than 140 mm Hg and the abrupt onset of hypertension in a patient with no history of hypertension or in one with well-controlled hypertension.
Initially, your patient may complain of a severe, generalized headache and restlessness. This may progress to nausea and projectile vomiting. His neurologic signs and symptoms may include confusion, drowsiness, stupor, and generalized tonicÂclonic or focal seizures. Because the encephalopathy results from emergency hypertension, he also may exhibit signs of impaired cardiovascular and renal function, such as myocardial ischemia and a decreased glomerular filtration rate.
Retinal damage also can result from hypertensive encephalopathy. An ophthalmic examination may reveal retinal hemorrhages, exudates, and papilledema-a condition known as grade I.V. hypertensive retinopathy.