Hypertensive cerebral crisis
Hypertensive cerebral crisis — a sharp increase in blood pressure to the highest levels. This disease leads to circulatory failures in the brain. As a rule, the symptoms of a hypertensive cerebral crisis depend on its type, but doctors also distinguish common symptoms, including headache, mental abnormalities accompanied by focal symptoms.
The content of the article:
Classification of hypertensive cerebral crisis
Pathogenesis of hypertensive cerebral crisis
Symptoms of hypertensive cerebral crisis
Diagnosis of hypertensive cerebral crisis
Treatment of hypertensive cerebral crisis
Prevention of hypertensive cerebral crisis
Hypertensive cerebral crisis
Treatment of hypertensive cerebral crisis is usually complex and includes sedative and antihypertensive therapy. Treatment is selected depending on the crisis. Most often, antispasmodics and venotonics are prescribed.
It should be said that hypertensive cerebral crisis refers to one of the types of hypertensive crisis. Very often, its development is observed against the background of an already existing hypertension with an accompanying increase in the load on the part of the brain that is responsible for the tone of the cerebral vessels.
This condition can also occur with the development of other diseases that contribute to an increase in blood pressure. For example, very often a hypertensive cerebral crisis occurs when:
atherosclerosis;
glomerulonephritis;
diabetic nephropathy;
pyelonephritis;
primary hyperaldosteronism.
In fifty percent of all cases, a hypertensive cerebral crisis will be a consequence of a stressful state. Other external factors that contribute to the disruption of the normal functioning of the cerebral vessels are considered to be sudden changes in the weather, excessive physical fatigue, hypothermia, malnutrition or overeating.
Classification of hypertensive cerebral crisis
Depending on the mechanism of development of pathological abnormalities against the background of arterial hypertension in the vessels of the brain, experts distinguish the following types of this disease:
angiohypotonic;
ischemic;
complex hypertensive.
An angiopathic type of hypertensive cerebral crisis occurs due to decreased vascular tone in the brain. In addition, its appearance is affected by the deposition of blood in the venous system, which is manifested by increased intracranial pressure.
The prerequisite for an ischemic type of crisis is oxygen starvation of the layers of the brain, which occurs due to a sharp reflex spasm of the arteries in the brain as a response to an increase in blood pressure.
A complex type of hypertensive cerebral crisis is a combination of the above two mechanisms.
There is another classification of hypertensive cerebral crisis — depending on the presence of complications , there are:
complicated crisis;
uncomplicated crisis.
Hypertensive cerebral crisis is dangerous for its complications, including ischemic stroke, transient ischemic attack, rupture of a cerebral aneurysm, and so on. In pregnant women, eclampsia will be a frequent manifestation of this disease.
Pathogenesis of hypertensive cerebral crisis
In a healthy state of the human body, the regulation of blood circulation in the brain works according to the following principle: when blood pressure rises, there is an increase in the tone of the cerebral arteries, which helps to avoid excessive blood flow to the brain. If this mechanism is disrupted, then it is possible to manifest a tonic reaction of the cerebral arteries in an excessive or insufficient form.
If the tonic reaction of the cerebral vessels in the event of an increase in blood pressure is insufficient, a blood breakthrough into the vessels of the brain is possible. However, even here the protective reaction of the body is activated in the form of a second compensatory mechanism, which should increase the tone of the venous vessels. With proper operation, such a mechanism accelerates the outflow of excess blood from the cranial cavity. If there is a failure of the mechanism here, then an angiohypotic type of hypertensive cerebral crisis develops, which is based on stagnation due to the accumulation of excessive fluid in the skull.
If, in response to a jump in blood pressure, the tone of the arteries also increases, then this can lead to disruptions in the blood supply to brain tissues with the further development of oxygen starvation (hypoxia), which will entail an ischemic type of hypertensive cerebral crisis.First of all, the cerebral cortex will suffer, since it is most sensitive to hypoxia. The uneven structure of the cerebral vessels leads to local angiospasm, which affects the occurrence of foci with pronounced ischemia.
In the pathogenesis of a complex type of hypertensive cerebral crisis, there is a tendency to hypotension of cerebral vessels with a further process of venous blood deposition. There may also be ischemia of different parts of the brain, and the reason for this is the deterioration of blood flow in the capillaries, which is a consequence of the release of blood from the arteries into the veins, while bypassing the capillary network.
Symptoms of hypertensive cerebral crisis
Angiohypotonic crisis
The angiohypotonic type of hypertensive cerebral crisis often develops as a consequence of such a symptom familiar to all hypertensive patients as headache, which is most often manifested in the occipital part by a feeling of a “heavy” head. Often the headache worsens while lying down or bending, because there is a difficulty in the venous outflow from the skull.
Headache is the first sign of cerebral angiodystonia. Such pain passes if the patient assumes an upright position of the body or drinks a caffeinated drink.
If the headache spreads to the retroorbital region, this indicates the onset of a hypertensive cerebral crisis. The main complaint will be eye pressure and pressure behind the eyeballs. The main distinguishing feature of the disease is its occurrence with a normal increase in blood pressure (up to 170/100 mm hgst). After that, there is a sharp increase in headache with its further spread throughout the entire area of the head.
Among other symptoms of hypertensive cerebral crisis:
nausea;
vomiting;
excessive sweating;
wave-like breathing;
tachycardia;
cyanosis of the face.
If we talk about the late phase of the disease, it is characterized by nystagmus, inhibited attention of the patient and dissociation of tendon reflexes. As a rule, during this phase, blood pressure rises to 220/120 mm Hg.
Ischemic crisis
The ischemic type of hypertensive cerebral crisis is much less common than the angiohypotonic type of the disease. Most often, it is diagnosed in hypertensive patients who have not previously felt headaches, and felt relatively well with an increase in blood pressure.
Very often, this type of crisis manifests itself against the background of already existing high blood pressure indicators. It happens that such indicators even go beyond the norm. The clinic of the disease may be implicit for a long time. Often the first manifestations of the crisis are expressed in the form of mental disorders (excessive physical activity, an overabundance of emotions, followed by depression and tearfulness, often characterized by aggressive behavior). Patients themselves are extremely rarely able to objectively assess their behavior.
At a further stage of the development of this type of crisis, there is a manifestation of focal symptoms in the form of visual impairment (there may be a feeling of flashing “flies” in front of the eyes or diplopia). Patients have a sensitivity disorder, which can be expressed in numbness or tingling of the extremities, impaired coordination of movements, speech disorders, vestibular ataxia, and so on.
Difficult crisis
A complex type of hypertensive cerebral crisis begins with symptoms that are characteristic of the angiohypotonic type, but often occurs against the background of already elevated arterial pressure. As the crisis develops, there is a manifestation of focal symptoms, most inherent in the ischemic type of crisis. The very nature of the severity of symptoms will depend on the location of the areas of brain tissue that has undergone ischemia.
Diagnosis of hypertensive cerebral crisis
The diagnosis of hypertensive cerebral crisis is carried out by a therapist, cardiologist or neurologist. The disease is detected on the basis of its inherent clinical symptoms, as well as previously taken into account data indicating the development of symptoms. If we talk about instrumental studies, they are usually carried out after a person is given first aid. Instrumental studies are aimed at a deeper diagnosis of cerebral circulation, as well as the state of the cardiovascular system.
Usually such studies include:
daily measurement of blood pressure;
ECG;
EEG;
rheoencephalography;
UZDG;
ophthalmoscopy;
MRI of the brain;
perimetry.
It is necessary to distinguish hypertensive cerebral crisis from ischemic or hemorrhagic strokes, acute hydrocephalus (which is observed in brain tumors).
Treatment of hypertensive cerebral crisis
Hospitalization will be necessary in the case of ischemic and mixed types of hypertensive cerebral crisis. If we talk about the uncomplicated form of angiohypotonic crisis, then its treatment in the hospital will be determined by the severity of this form.
Treatment of any type of hypertensive cerebral crisis should be comprehensive, which implies general therapy (tranquilizing and antihypertensive). In addition, vasoactive drugs are prescribed by specialists (depending on the type of ongoing crisis), and symptomatic treatment is not excluded.
It is very important in the treatment of hypertensive cerebral crisis to observe bed rest until complete stabilization of blood pressure and complete disappearance of neurological clinical manifestations.
Hypotensive therapy of a cerebral crisis usually takes place with traditional emergency measures, as in the case of a hypertensive crisis. The use of vasodilators or so-called calcium channel blockers is not excluded. In addition, they prescribe: ACE inhibitors and beta-blockers. Tranquilizers such as relanium, seduxen, phenazelam, elenium are prescribed first of all, because these drugs help to cope with emotional stress, fear and panic attacks that develop against the background.
Vasoactive drugs are usually administered intravenously by drip or jet method. The ischemic type of hypertensive cerebral crisis is well eliminated by the administration of devincan. The use of no-shpa, papaverine or eufillin is not excluded.
Venotonics are used in the treatment of angiohypotonic type of crisis. The active effect is provided by caffeine, but it cannot be used in the case of gastric extrasystole and coronary heart disease, and is also not recommended for hypersensitivity of the patient’s body. Usually, the use of caffeine is prescribed together with no-shpa or devincan.
Prevention of hypertensive cerebral crisis
The main preventive measure of this disease will be proper hypotensive therapy in the case of hypertension.With even a slight increase in blood pressure, it is necessary to exclude work related to physical exertion, inclines or a constant fixed position of the body. You should also not overcool (especially the head), it is necessary to avoid emotional overload.
If a person has a headache every day in the morning, you should use a high pillow for sleeping, and also take a walk in the fresh air before going to bed. It should be remembered that an increasing headache may be a sign of a developing cerebral crisis. In order to avoid this, you should regularly massage the neck-collar area, warm your head with a warm shower or drink strong tea. In case of severe headaches, it is necessary to take caffeine tablets (or seduxen). In case of increased headache, hypertensive patients are recommended to take bellaspon or vincapan for the next two weeks.
It is always necessary to focus attention and not ignore the symptoms that have appeared, since they are often a warning signal of such a serious disease as a hypertensive cerebral crisis, occurring in one of the three forms presented above. It is much easier to prevent the disease than to treat it later using complex therapy.
