Brain ischemia, strokes, heart attacks and encephalopathies are considered serious illnesses. Often they are fatal. Among a large number of brain pathologies, encephalopathy deserves special attention. This is an extensive group of diseases. They are characterized by dystrophic changes in the brain tissue and lead to impaired function. The etiology of ailments is different, 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 target organs are most affected. These include the kidneys, heart, and brain.
During a moderate increase in blood pressure, a protective mechanism of the narrowing of blood vessels is activated , which prevents their rupture. With stable arterial hypertension, the muscle layer of the walls of the arteries gradually thickens, hypertrophies. The lumen of the vessels narrows, which leads to a constant deficiency of oxygen in the body. A hypertensive form of ischemia develops, which is also called discirculatory encephalopathy.
A rapid and marked increase in blood pressure provokes damage to the inner lining of the vessels. A severe spasm of arterioles is replaced by paralysis. At the same time, passive extension of the walls of small blood vessels occurs. This condition is called hypertensive encephalopathy. It is characterized by phased development. Therefore, if you notice the symptoms of the disease in a timely manner and consult a doctor, negative consequences can be avoided.
Hypertensive encephalopathy - what is it?
This is a pathological condition that develops in the brain tissue as a result of a persistent uncontrolled increase in blood pressure. What parameters are considered deviations from the norm? Arterial hypertension is considered an increase in systolic pressure in excess of 140 mm RT. Art., and diastolic - more than 90 mm RT. Art. In 1928, scientists Oppenheimer and Fischberg described the symptoms and pathogenesis of a disease such as hypertensive encephalopathy (ICD-10 code - I-67.4).
Causes of pathology
To understand the etiology of the disease, you need 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 the causes of sharp jumps in blood pressure can be divided into congenital and acquired. Doctors note that the risk of hypertension increases several times if the 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, factors associated with a person's lifestyle play a primary role in the development of hypertension. These include the following:
- addictions;
- high cholesterol;
- intoxication of the body;
- drug overdose;
- some diseases.
It should be noted that constantly increased pressure rarely contributes to the development of the disease. The vessels of the brain gradually adapt to this condition. Sudden pressure surges are considered the most dangerous. They can trigger vasospasm and ischemia.
Clinical manifestations
There are two forms of the course of the disease. Acute hypertensive encephalopathy is characterized by reversible disorders. They pass after stopping edema and restoration of blood circulation. Symptoms of chronic encephalopathy at the initial stage are weakly expressed, 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 form of the disease
Acute hypertensive encephalopathy develops during the current crisis, and blood pressure may vary. In patients with experience, it is considered critical to increase the pressure to the level of 180-190 mm RT. Art. In individuals prone to hypotension, this threshold is slightly lower and amounts to 140/90 mm Hg. Art.
Among the main symptoms of the acute form of the disease, the following are distinguished:
- severe headache localized in the occipital part;
- nausea, vomiting;
- sudden visual impairment;
- convulsive seizures;
- unexpressed peripheral paresis;
- stunning state.
If these symptoms appear, you must urgently seek medical help.
Chronic form of the disease
Chronic hypertensive encephalopathy develops gradually. Each stage is characterized by a specific clinical picture.
At the first stage, the primary signs of the disease appear, which can be confused with the manifestations of other ailments. For example, severe headaches are attributed to stress, trying to stop them with conventional analgesics. Also, patients complain of distracted attention, tinnitus, weakness throughout the body. Such symptoms are rarely noticed, especially in old age. As a result, hypertensive encephalopathy proceeds 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 changes in mood). Hypertensive encephalopathy of the 2nd degree affects the performance of a person. He gets tired very quickly, motivation disappears, the ability to organize his own activities. Sometimes concomitant behavioral disorders serve as a reason for consultation with a psychiatrist.
In the third stage, existing neurological disorders are exacerbated. With focal brain damage, epileptic seizures are not excluded . In elderly patients, hypertensive encephalopathy often provokes the development of Parkinson's syndrome.
Medical examination
Diagnosis of the disease is carried out on the basis of patient complaints, medical history, general symptoms. The results of previous surveys are also used. The difficulty of diagnosis may be that the manifestations of encephalopathy are similar to the clinical picture of other pathologies. The latter include a brain tumor, stroke. Therefore, before prescribing therapy, the patient must undergo a series of tests:
- blood and urine tests;
- MRI, CT of the brain;
- echocardiography;
- electroencephalography.
Additionally, you may need to consult third-party specialists (cardiologist, therapist, nephrologist, endocrinologist).
Treatment principles
The acute form of the disease requires immediate hospitalization. The patient is determined in the intensive care unit, where all vital signs are constantly monitored.
What medications are prescribed for the diagnosis of hypertensive encephalopathy? Treatment begins with a decrease in blood pressure. To do this, use the following drugs:
- Diazoxide.
- "Hydralazine."
- Nitroprusside.
- "Nitroglycerine".
The most effective is Diazoxide. Under its influence, the pressure indicators equalize for 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, therefore it is contraindicated in patients with cardiac ischemia.
Ganglion blockers are also used to normalize blood pressure in hypertensive encephalopathy. The following drugs are included in this group of medicines:
- "Labetalol".
- Pentolinium.
- "Phentolamine."
- "Trimethafan."
The listed medicines are characterized by quick action, but at the same time they have many side effects. During pregnancy, their use is strictly prohibited, since there is a possibility of a miscarriage.
The chronic form of the disease, like the acute one, according to ICD-10 has the code I-67.4. At the initial stages, progressive type hypertensive encephalopathy has similar symptoms to it, but the therapy is somewhat different. In the chronic form of the disease, metabolic agents, vitamins, nootropics are prescribed simultaneously with antihypertensive drugs. The most commonly used are Trental, aspirin preparations, and Dipyridamole. In severe behavioral disorders, sedatives and antidepressants are used. Competent and timely therapy helps to reduce the rate of progression of a disease such as hypertensive encephalopathy.
Is a disability group available?
This logical 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 former opportunities and full life. Disability with encephalopathy is possible, especially with the second and third degree. It is assigned by decision of the medical board. Evaluation of the patient's health is carried out not only according to his medical history, but also according to the results of the examination and health analysis.
Preventive measures
Hypertensive encephalopathy is a serious disorder that affects the work of the whole organism. It is safe to say that this disease is a mandatory complication of hypertension in the absence of quality treatment. Compliance with simple rules of prevention helps prevent its occurrence.
First of all, it is necessary to monitor blood pressure indicators. Most often, problems with pressure in a modern person appear due to his lifestyle. Improper nutrition, constant stress, lack of exercise, bad habits - these factors sooner or later lead to an ailment. Therefore, practicing feasible sports, the right diet and a positive attitude will help keep the vessels in a healthy state for a long time.