Diagnosis and treatment

Hypertensive encephalopathy must be distinguished from intracranial tumours, cerebrovascular events and uraemia.

Diagnosis therefore entails:

• serial measurement of high blood pressure
• CT - shows widespread white matter attenuation and excludes most alternative pathology
• MRI or radiographic contrast study } exclusion of
• urinalysis and estimation of blood urea } differentials

Treatment involves:

• aim - gradual reduction of diastolic blood pressure to 100 - 110 mm Hg
• method:
  • labetalol, especially in suspected phaeochromocytoma
  • nitroprusside or diazoxide by slow iv infusion
  • peritoneal dialysis for resistant cases