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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The clinical and pathologic findings in 20 patients with hypertensive encephalopathy were reviewed. The dominant central nervous system (CNS) symptoms were altered state of consciousness and severe headache. Nausea, vomiting, and visual disturbances were less common. Seizures and focal signs were infrequent. The changes seen were invariably accompanied both by the characteristic ophthalmoscopic alterations of malignant hypertension and by uremia. The neuropathologic changes consisted of severe vascular alterations (fibrinoid necrosis of arterioles, thrombosis of arterioles and capillaries), and of parenchymal lesions (microinfarcts, petechial hemorrhages) secondary to the vascular lesions. The vascular changes were not confined to the brain but were diffuse, affecting the eyes, kidneys, and other organs. In the CNS the brainstem was most severely affected. Cerebral edema was not observed, even in those patients who had increased cerebrospinal fluid pressure and papilledema.
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PMID:Hypertensive encephalopathy: a clinicopathologic study of 20 cases. 56 64

The hypertensive encephalopathy is a syndrome consisting of a sudden elevation of arterial pressure usually preceded by severe headache and followed by convulsions, coma or a variety of transitory cerebral phenomena. The syndrome may complicate acute glomerulonephritis, toxemia of pregnancy and essential or malignant hypertension. Two syndromes must be differentiated from true hypertensive encephalopathy: 1. acute anxiety state with labile hypertension and 2. acute pulmonary edema due to hypertensive heart disease. At least in patients with acute anxiety states, the use of antihypertensive agents is usually not indicated. Since encephalopathy is always accompanied by increased vascular resistance and since clinical experience has demonstrated clearing of the sensorium, cessation of convulsions and release of vasoconstriction following reduction of blood pressure, the primary aim of therapy should be prompt lowering of arterial pressure. The two agents of choice are diazoxide and sodium nitroprusside. Stroke is differentiated from encephalopathy by the persistence of lateralizing signs. The aggressiveness of antihypertensive therapy in this situation depends on the severity of the hypertensive process. Rapid reduction of blood pressure is indicated in patients found to have accelerated hypertension while a more gradual lowering of pressure appears warranted for patients with chronic arterial hypertension and evidence of generalized arteriosclerosis.
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PMID:Management of hypertensive encephalopathy. 72 Oct 56

There have been numerous accounts of women on ovulation inhibitors developing hypertension or reactifying or intensifying previous hypertension. Concerning frequency of significant hypertension in pill users, there are reports varying from .66% (or even 0%) to 19%. The time interval between start of medication and manifestation of hypertension also varies according to different sources from 7 days to 5 years, with the critical point usually around 6-8 weeks. Degree of hypertension after ovulation inhibitors ranges from mildly significant increases in systolic and/or diastolic blood pressure to malignant hypertension with irreversible kidney insufficiency. Early observable symptoms of hypertension include migrainelike headaches and rapid weight gain (sodium and water retention). After discontinuation of the medication, normal blood pressure is attained either within a few days or after 6-8 months. If normalization of blood pressure does not occur spontaneously there may be other causes (e.g., secondary vascular disorders). Concerning pathogenesis of ovulation-inhibitor-related hypertension, changes (increases) in the renin-angiotensin-aldosterone system are assumed to play a major role (almost all women on the pill exhibit elevated renin-angiotensin-aldosterone activity). Sodium retention may also be determinative. Many clinical and laboratory studies have demonstrated that it is the estrogen content of ovulation inhibitors that is responsible for the increased plasma renin activity. The study recommends: 1) women who wish oral contraceptive therapy should give careful family and personal histories and be tested for blood pressure before and during treatment (monthly, then after 6 months twice yearly); 2) careful supervision is indicated for women with high blood pressure or other cardiovascular disorders in their history, present or former kidney disorders, arterial hypertension, pregnancy toxemias, adipositas, or diabetes mellitus; 3) abnormal weight gain may be an early symptom; 4) if any rise in blood pressure is observed, ovulation inhibitor medication should be discontinued immediately; and 5) ovulation inhibitor-induced hypertension should be considered in differential diagnosis in young women with arterial hypertension.
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PMID:[Oral contraceptives and arterial hypertension]. 437 45

140 cases of malignant hypertension were diagnosed in our clinic from January 1966 to December 1982. On admission the mean blood pressure was 183 +/- 17 mm Hg, and all patients had grade III to IV retinopathy according to the Keith and Wagener classification; 84% of the patients had renal failure (10% of acute origin). 43% of the patients presented with clinical signs of left heart failure. Hypertension was associated with various renal diseases in 48%, was essential in 41%, and renovascular lesions were found in 9% of the cases. Headaches, asthenia and visual disorders were the 3 main symptoms of malignant hypertension, as classically described. Severe cerebral damage (including all the neurological manifestations present on admission) was found in 27% of the patients. Among the 122 patients available to follow-up, half died during the study period. The survival rate, calculated on a 5-year basis, has doubled compared with a similar patient population 17 years ago, increasing from 35% (period 1966 to 1970) to 72% (period 1977-1982). This remarkable achievement in survival rate is due to more intensive research and therapeutic progress (including, more recently, extrarenal epuration) reaching an increasingly large hypertensive population.
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PMID:[Malignant arterial hypertension, symptomatic and prognostic aspects. Retrospective study of 140 cases]. 651 87

To investigate age-related differences in malignant hypertension (MHT), we studied 38 elderly patients (18 males, 20 females; mean age 70.6 years, SD 4.6 years, range 65 to 84) and 277 younger patients (193 males, 84 females; mean age 46.4 years, SD 10.5, range 15 to 64) with MHT presenting 1965-93. Mean duration of known hypertension before presentation was greater in the elderly group (43.8 months vs. 23.1 months). The elderly group included 18 (47.4%) newly diagnosed hypertensives, compared to 160 (55.8%) in the younger group. At presentation, 19 (50.0%) elderly patients were receiving no antihypertensive drug therapy, whilst 18 (47.4%) were taking one or more drugs for hypertension. Presenting clinical features in elderly MHT patients included visual disturbance (9), headaches (2), headaches with visual disturbance (2), stroke (3), and heart failure (2). Six patients were asymptomatic. The commonest clinical complications were ischaemic heart disease (angina and myocardial infarction) (5), heart failure (4) and stroke (4). The majority (58%) of patients, however, had no vascular complications at presentation. Comparing elderly and younger MHT groups, there was no significant difference in presenting systolic blood pressures, although mean diastolic blood pressure was significantly greater in the younger group (mean 143.7 mmHg +/- 19.3 vs. 130.0 mmHg +/- 15.2; p < 0.0001). After a mean follow-up of 30.9 months (SD 37.1; range 1 to 123 months), 17 (44.7%) of the elderly patients were still alive, 15 were dead (39.5%) and six were lost to follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Malignant hypertension in the elderly. 758 78

Although an association between oral contraceptives (OCs) and arterial hypertension has been well-documented, most studies have found only mild or moderate hypertension with reversal to normal levels 3 months after OC discontinuation. This paper presents two cases in which young women developed severe left ventricular hypertrophy and renal failure due to OC-induced malignization of hypertension. The first patient, a 23-year-old, was admitted to the hospital with a 3-day history of headache, mental confusion, and aggressiveness. 6 months before presentation, severe arterial hypertension had been diagnosed. At that time, she was advised to discontinue OCs (30 mcg of ethinyl estradiol and 150 mcg of levonorgestrel), which she had been taking for a year; she did not comply with this directive. The second patient, 21 years old, was admitted with accelerating hypertension. She had initiated OC use (30 mg of ethinyl estradiol and 150 mcg of levonorgestrel) 6 months earlier. 3 months after starting OC use, she developed headache and fatigue. Both women had a hemorrhagic cerebral accident as a complication of malignant hypertension. All neurologic, renal, and cardiovascular complications were reversible after OC discontinuation. OC-related malignant hypertension can be averted through effective control of blood pressure in OC users.
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PMID:Cardiac and neurologic complications in malignant hypertension due to oral contraceptive use. 786 96

Hypertensive encephalopathy is an uncommon but recognized complication of malignant hypertension in children. We reviewed the clinical course, laboratory studies, and outcomes of 12 patients with hypertensive encephalopathy seen at the University of Iowa Hospitals and Clinics between 1979 and 1994. The most common presenting symptoms were seizures, headache, and vision changes. Laboratory studies were nonspecific and in some patients were normal. Hypertensive encephalopathy is a clinical diagnosis. Management consists of recognition of this syndrome and aggressive treatment of hypertension. The neurologic outcome in our series was good.
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PMID:Hypertensive encephalopathy in childhood. 873 20

Patients with severe hypertension with retinoscopic bilateral papilloedema only are not classically regarded as having malignant hypertension (MHT). We have encountered 23 such patients between 1965-1993, whilst over a similar period we have seen 315 patients who fulfilled the conventional criteria for MHT with bilateral retinal haemorrhages, exudates with or without papilloedema. We hypothesised that patients with "lone" papilloedema and severe hypertension were suffering from a disease which was identical in aetiology and outcome to conventional MHT. There were no significant differences in age, mean blood pressure, proteinuria or renal function at presentation, ethnic composition, smoking status and followup blood pressure control between the papilloedema group and those presenting with conventional MHT. Clinical features at presentation in the papilloedema only group included strokes in 4, visual disturbance in 2, headaches in 3 and heart failure in 1 patient. Many patients however had no complications at presentation. After a mean followup of 59.8 months, of the "lone" papilloedema group, 7 patients (30.4%) were still alive, 1 patient was on renal dialysis therapy, 13 were dead (56.5%) and 2 (8.7%) were lost to followup. The commonest causes of death were stroke in 4 patients, renal failure in 4 and heart disease in 2. This was a similar pattern of mortality to those patients with "conventional" MHT. Lifetable analyses showed a median survival of 35.9 months for the papilloedema group which was significantly worse than the 108.7 months for the conventional MHT group (Lee-Desu statistic 4.04, p = 0.045). We suggest that patients with high blood pressure and lone bilateral papilloedema may comprise a hitherto unrecognised subgroup of patients with MHT. Once intracerebral pathology has been excluded, these patients need to be treated as aggressively as those with MHT.
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PMID:Severe hypertension with lone bilateral papilloedema: a variant of malignant hypertension. 874

A 43 year old intravenous drug abuser presented to the accident and emergency department with a three week history of bilateral visual loss and frontal headaches. Fundoscopy revealed bilateral retinal cotton wool spots and haemorrhages and an ophthalmic opinion was requested. His blood pressure was subsequently found to be 210/140. A diagnosis of malignant hypertension was made and blood pressure was gradually controlled on oral antihypertensives. This case illustrates the importance of checking the blood pressure of all patients presenting with visual loss.
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PMID:Malignant hypertension presenting as blurred vision in a 43 year old intravenous drug abuser. 919 91

Association between mild to moderate hypertension and headache is probably coincidental. Severe sustained hypertension, malignant hypertension and paroxysmal hypertension (sudden rise) are associated with severe headache. Transient hypertension can occur during an attack of migraine or cluster headache. Hypertension may increase the frequency and severity of migraine in migraineurs and may transform an episodic migraine into chronic daily headache. Concomitant treatment of hypertension is important in these patients.
Cephalalgia 1999 Dec
PMID:Migraine and hypertension. 1066 13


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