Hypertensive encephalopathy is generally seen in children with renal disease, e.g. acute glomerulonephritis or ESRD.
Signs and symptoms include bp >99th percentile for age and height and neurologic impairment. May present acutely with seizure or coma, or subacute with HA, vomiting, lethargy, blurry vision or change in mental status. Exam findings may also include papilledema.
MRI may show increased signal in occipital lobes of T2 weighted images, known as reversible posterior leukoencephalopathy.
Treatment is to lower BP by 20-25% for the first 8 hours and to normative levels over 24-48 hrs. IV therapy with esmolol drip, labetalol or nicardapine are the treatments of choice. Nitroprusside prudent in most hypertensive adult emergencies must be used cautiously if history of renal disease secondary to cyanide toxicity. Seizure should also be treated as you would with status epilepticus.
References
Belsha CW - Ann Emerg Med - 01-MAR-2008; 51(3 Suppl): S21-3
Herman, Andrea "Visaul Diagnosis: A Child Who Has a Nosebleed and High Blood Pressure." Pediatrics in Review 2001 22:104-107
Kleigman et al. Nelson Textbook of Pediatrics. 18th edition 598.3.
