Most patients with hypertensive encephalopathy have a history of hypertension. In patients who do not have a prior history of hypertension, place emphasis on the past medical history, the medication list, and medication compliance. Actively seek drug-induced causes, for example, sympathomimetic agents and illicit drugs such as cocaine. [5]
Patients usually have vague neurologic symptoms and may present with symptoms of headache, confusion, visual disturbances, seizures, nausea, and vomiting. Headaches are usually anterior and constant in nature. The onset of symptoms usually occurs over 24-48 hours, with neurologic progression over 24-48 hours.
Patients also may present with symptoms resulting from other end-organ damage. [6] Examples of these symptoms include the following:
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Cardiovascular symptoms of aortic dissection, congestive heart failure, angina, palpitations, irregular heartbeat, or dyspnea
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Renal hematuria and acute renal failure
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Papilledema. Note the swelling of the optic disc, with blurred margins.
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Hypertensive retinopathy. Note the flame-shaped hemorrhages, soft exudates, and early disc blurring.