Hypertension Blog

Diagnostic Tests

Computed tomography (CT) and magnetic resonance imaging help rule out other causes of your patient’s severe headache, such as a CVA. Imaging may reveal areas of hemorrhage ranging in size from pinpoint to massive.

A lumbar puncture is contraindicated because of the patient’s high ICP. Introducing a needle into the central canal of his spinal cord would cause cerebrospinal fluid (CSF) to gush, and the sudden and dramatic decrease in CSF could force delicate brain tissue to herniate into the spinal canal, resulting in immediate death

Usually, a physician prescribes an antihypertensive drug to rapidly reduce ICP and arterial blood pressure and to maintain diastolic blood pressure at about 100 mm Hg. The drugs used to treat hypertensive encephalopathy include vasodilators, beta-blockers, and osmotic diuretics. Most commonly, a physician prescribes the vasodilator nitroprusside. Vasodilators relax vascular smooth muscle, which reduces peripheral artery and vein dilation. Beta-blockers may be used to reduce vascular resistance.

The physician may prescribe mannitol, an osmotic diuretic, if the patient already shows signs and symptoms of cerebral edema. Although osmotic diuretics reduce ICP, they’re contraindicated in patients with active cerebral bleeding. The adverse effects of osmotic diuretics-confusion, convulsions, dizziness, disorientation, headache, rebound increased ICP, and syncope-can mimic a worsening neurologic condition .

Although rapidly reducing your patient’s blood pressure will dramatically improve the symptoms of hypertensive encephalopathy, he’ll require continued close monitoring in an ICU.