How is hypertensive encephalopathy diagnosed?
Such patients typically present with very high blood pressures and altered mental status.
Optic fundi may show Grade III (hemorrhages/exudates) or IV (papilledema) retinopathy.
Usually other evidence of hypertensive target-organ damage is present, such as hematuria, elevated serum creatinine, or left ventricular hypertrophy.
Although the differential diagnosis in such a patient is long and complex, consideration can be given to starting a short-acting, easily titratable, intravenous antihypertensive agent while transporting the patient to the computed tomographic scanner.
It is rewarding to see an improvement in central nervous system function after the blood pressure is reduced even by 10%.
However, other causes of stupor and coma have to be considered, appropriately evaluated, and eliminated before one can make the diagnosis of hypertensive encephalopathy.
