Hypertensive Encephalopathy

Introduction

Hypertensive encephalopathy is an acute syndrome characterized by acute hypertension (HTN) associated with various neurological symptoms and characteristic neuroimaging findings. The common clinical signs and symptoms of the condition include encephalopathy, seizures, headache, visual disturbances, and focal neurological deficits . Hypertensive encephalopathy is an important clinical syndrome to recognize since early recognition and treatment can lead to good clinical outcomes. We now have an ever-increasing choice of antihypertensive medications that are easily titratable at our disposal. It is difficult to discuss hypertensive encephalopathy without discussing posterior reversible encephalopathy syndrome (PRES). PRES is a syndrome characterized by acute neurological symptoms associated with typically posterior vasogenic edema that is often reversible if the underlying etiology is treated rapidly. As will become clearer later on in this chapter it is now abundantly clear that PRES is not always posterior and also not always reversible, but for now this remains the most commonly used terminology to describe this syndrome. Since the publication of the prior issue of this book there has been increasing recognition that hypertensive encephalopathy represents one of the many manifestations of PRES. I therefore focus on important aspects regarding pathophysiology, imaging characteristics, and treatment as it relates to PRES and hypertensive encephalopathy.