Arterial hypertension and posterior reversible encephalopathy syndrome


DOI: https://dx.doi.org/10.18565/therapy.2022.9.68-74

Martynov M.Yu., Gudkova V.V., Koltsova E.A., Razinskaya O.D., Abramenkova N.N., Solntsev E.S., Ulyanov D.I., Chuprina S.E.

1) N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia, Moscow; 2) Federal Center for Brain and Neurotechnologies of the Federal Medical and Biological Agency of Russia, Moscow; 3) War Veteran’s Hospital No. 3 of the Department of Healthcare of Moscow; 4) Voronezh Regional Clinical Hospital No. 1, Voronezh
Abstract. The cardiological and neurological interdisciplinary aspects of posterior reversible encephalopathy syndrome (PRES) as a variant of acute hypertensive encephalopathy are presented in the article. The aim of the article is to draw attention of the clinicians to the rare complication of hypertensive crisis and acute hypertensive encephalopathy – PRES. Fast and accurate medical diagnostic and treatment can prevent transformation of this reversible condition (vasogenic edema of the brain) into severe neurological complications. In this article the clinical and radiological aspects of typical and atypical PRES variants are analyzed. Special attention is devoted to the clinical presentations of PRES in the settings of hypertensive crisis: the possibility of formation of the «central variant» of PRES with clinical-radiological dissociation, hemorrhagic transformation and other complications. The main treatment strategy in patients with PRES and hypertensive crisis is a stepwise lowering of blood pressure (BP). Within the first 2–4 hours the BP should be lowered no more than 20–25% of the initial blood pressure, with gradual reduction within the next 24 hours.
Keywords: renal/hepatic insufficiency, cerebral blood flow autoregulation, brain edema, acute hypertensive encephalopathy, posterior reversible encephalopathy syndrome (PRES), hypertensive crisis, arterial hypertension, CT, MRI
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About the Autors

Mikhail Yu. Martynov, Dr. med. habil., professor, corresponding member of RAS, first deputy director of Federal Center for Brain and Neurotechnologies of FMBA of Russia, professor of the Department of neurology, neurosurgery and medical genetics, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 119415, Moscow, 42/6 Lobachevskogo Str. E-mail: m-martin@inbox.ru. ORCID: https://orcid.org/0000-0003-2797-7877
Valentina V. Gudkova, PhD in Medicine, professor of the Department of neurology, neurosurgery and medical genetics,
N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 119415, Moscow, 42/6 Lobachevskogo Str. E-mail: gudkova.valentina@gmail.com.
ORCID: https://orcid.org/0000-0002-9646-9131
Evgenia A. Koltsova, PhD in Medicine, professor of the Department of neurology, neurosurgery and medical genetics,
N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 119415, Moscow, 42/6 Lobachevskogo Str. E-mail: koltsovaevgenia@rambler.ru.
ORCID: https://orcid.org/0000-0001-6459-2656
Olga D. Razinskaya, assistant at the Department of neurology, neurosurgery and medical genetics, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 119415, Moscow, 42/6 Lobachevskogo Str. E-mail: july2000@mail.ru. ORCID: https://orcid.org/0000-0002-6531-0814
Natalya N. Abramenkova, neurologist at the 8th Neurological Department for patients with acute disorders of cerebral circulation, War Veteran’s Hospital No. 3 of the Department of Healthcare of Moscow. Address: 129336, 129336, Moscow, 4 Startovaya Str. E-mail: vedmochka@mail.ru
Evgeny S. Solntsev, neurologist at the 8th Neurological Department for patients with acute disorders of cerebral circulation, War Veteran’s Hospital No. 3 of the Department of Healthcare of Moscow. Address: 129336, 129336, Moscow, 4 Startovaya Str. E-mail: solntsev.jenyok21@yandex.ru
Dmitry I. Ulyanov, head of the Neurological Department, War Veteran’s Hospital No. 3 of the Department of Healthcare of Moscow. Address: 129336, Moscow, 4 Startovaya Str. E-mail: ulan.11n.com@inbox.ru
Svetlana E. Chuprina, head of the Neurological Department for patients with cerebrovascular disorders, Voronezh Regional Clinical Hospital No. 1. Address: 394066, Voronezh, 151А Moskovsky Avenue. E-mail: chuprinasveta@mail.ru.
ORCID: https://orcid.org/0000-0002-2103-3771


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