Hypertensive encephalopathy, symptoms

Two severe acute reactions have recently been reported in connection with Intralipid therapy (Jellinek 1976). A 22-year-old female developed an acute clinical illness resembling hypertensive encephalopathy. Symptoms comprised headache, focal and generalized convulsions, and persistent cortical blindness. Daily minor parietal attacks persisted for several years. In the second case, a 76-year-old male, quadriplegia developed suddenly during Intralipid infusion. After 1 month, the left side remained paralyzed but he had limited use of a spastic right arm and leg. It is concluded that Intralipid may have precipitated acute thromboembolic cerebral vascular disease in these two cases. 

Elevated blood pressure should remain untreated in the acute period (first 7 days) after ischemic stroke because of the risk of decreasing cerebral blood flow and worsening symptoms. The pressure should be lowered if it exceeds 220/120 mm Hg or there is evidence of aortic dissection, acute myocardial infarction, pulmonary edema, or hypertensive encephalopathy. If blood pressure is treated in the acute phase, short-acting parenteral agents (e.g., labetalol, nicardipine, nitroprusside) are preferred. 

Ciclosporin-induced vasculopathy, with endothelial injury and derangement of the blood-brain barrier, is the postulated mechanism of neurological damage. Transient cerebral perfusion abnormalities, demonstrable in SPECT scans of the brain, have been suggested as a reliable indicator of ciclosporin neurotoxicity (SEDA-20, 344). Clinical symptoms as well as CT and/or MRI scans were very similar to those observed in hypertensive encephalopathy, with predominant and reversible white-matter occipital lesions (23). There was complete neurological recovery in most patients after blood pressure was normalized, and deaths due to intracranial hemorrhage are reported only exceptionally. 

Drug therapy for portal hypertension and cirrhosis can alleviate symptoms and prevent complications but it cannot reverse cirrhosis. Drug therapy is available to treat the complications of ascites, varices, spontaneous bacterial peritonitis, hepatic encephalopathy, and coagulation abnormalities. 

Exposure to lead in adults has been associated with hypertension, nephropathy, decreased hearing acuity, anemia, peripheral neuropathy, and encephalopathy. Onset of symptoms may be slow with chronic exposure. Anemia, common in chronically exposed adults and children, tends to be more severe in children. The life span of red blood cells decreases when lead concentrations in blood increase. In the past, the morphology of various blood cells was used to diagnose lead poisoning. Zero content is allowed in food (Food and Drug Administration). 

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