Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Clinical characteristics of hypertensive encephalopathy in pediatric patients

  • Ahn, Chang Hoon (Department of Pediatrics, Chonbuk National University Medical School) ;
  • Han, Seung-A (Department of Pediatrics, Chonbuk National University Medical School) ;
  • Kong, Young Hwa (Department of Pediatrics, Chonbuk National University Medical School) ;
  • Kim, Sun Jun (Department of Pediatrics, Chonbuk National University Medical School)
  • Received : 2017.02.22
  • Accepted : 2017.06.12
  • Published : 2017.08.15
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Abstract

Purpose: The aim of this study was to assess the clinical characteristics of hypertensive encephalopathy according to the underlying etiologies in children. Methods: We retrospectively evaluated 33 pediatric patients who were diagnosed as having hypertensive encephalopathy in Chonbuk National University Children's Hospital. Among the patients, 18 were excluded because of incomplete data or because brain magnetic resonance imaging (MRI) was not performed. Finally, 17 patients were enrolled and divided into a renal-origin hypertension group and a non-renal-origin hypertension group according to the underlying cause. We compared the clinical features and brain MRI findings between the 2 groups. Results: The renal group included renal artery stenosis (4), acute poststreptococcal glomerulonephritis (2), lupus nephritis (2), and acute renal failure (1); the nonrenal group included essential hypertension (4), pheochromocytoma (2), thyrotoxicosis (1), and acute promyelocytic leukemia (1). The mean systolic blood pressure of the renal group ($172.5{\pm}36.9mmHg$) was higher than that of the nonrenal group ($137.1{\pm}11.1mmHg$, P<0.05). Seizure was the most common neurologic symptom, especially in the renal group (P<0.05). Posterior reversible encephalopathy syndrome (PRES), which is the most typical finding of hypertensive encephalopathy, was found predominantly in the renal group as compared with the nonrenal group (66.6% vs. 12.5%, P<0.05). Conclusion: We conclude that the patients with renal-origin hypertension had a more severe clinical course than those with non-renal-origin hypertension. Furthermore, the renal-origin group was highly associated with PRES on brain MRI.

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References

  1. Gavrilovici C, Boiculese LV, Brumariu O, Dimitriu AG. Etiology and blood pressure patterns in secondary hypertension in children. Rev Med Chir Soc Med Nat Iasi 2007;111:70-81.
  2. Croix B, Feig DI. Childhood hypertension is not a silent disease. Pediatr Nephrol 2006;21:527-32. https://doi.org/10.1007/s00467-006-0013-x
  3. Immink RV, van den Born BJ, van Montfrans GA, Koopmans RP, Karemaker JM, van Lieshout JJ. Impaired cerebral autoregulation in patients with malignant hypertension. Circulation 2004;110:2241-5. https://doi.org/10.1161/01.CIR.0000144472.08647.40
  4. Klein IH, Ligtenberg G, Oey PL, Koomans HA, Blankestijn PJ. Sympathetic activity is increased in polycystic kidney disease and is associated with hypertension. J Am Soc Nephrol 2001;12:2427-33.
  5. Aggarwal M, Khan IA. Hypertensive crisis: hypertensive emergencies and urgencies. Cardiol Clin 2006;24:135-46. https://doi.org/10.1016/j.ccl.2005.09.002
  6. Ahmed ME, Walker JM, Beevers DG, Beevers M. Lack of difference between malignant and accelerated hypertension. Br Med J (Clin Res Ed) 1986;292:235-7. https://doi.org/10.1136/bmj.292.6515.235
  7. Hu MH, Wang HS, Lin KL, Huang JL, Hsia SH, Chou ML, et al. Clinical experience of childhood hypertensive encephalopathy over an eight year period. Chang Gung Med J 2008;31:153-8.
  8. Zheng H, Chen C, Zhang J, Hu Z. Mechanism and therapy of brain edema after intracerebral hemorrhage. Cerebrovasc Dis 2016;42:155-69. https://doi.org/10.1159/000445170
  9. Cherney D, Straus S. Management of patients with hypertensive urgencies and emergencies: a systematic review of the literature. J Gen Intern Med 2002;17:937-45. https://doi.org/10.1046/j.1525-1497.2002.20389.x
  10. Keith NM, Wagener HP, Barker NW. Some different types of essential hypertension: their course and prognosis. Am J Med Sci 1974;268:336-45. https://doi.org/10.1097/00000441-197412000-00004
  11. Wright RR, Mathews KD. Hypertensive encephalopathy in childhood. J Child Neurol 1996;11:193-6. https://doi.org/10.1177/088307389601100305
  12. O'Hara McCoy H. Posterior reversible encephalopathy syndrome: an emerging clinical entity in adult, pediatric, and obstetric critical care. J Am Acad Nurse Pract 2008;20:100-6. https://doi.org/10.1111/j.1745-7599.2007.00292.x
  13. Textor SC. Secondary hypertension: renovascular hypertension. J Am Soc Hypertens 2014;8:943-5. https://doi.org/10.1016/j.jash.2014.10.007
  14. Kapur G, Ahmed M, Pan C, Mitsnefes M, Chiang M, Mattoo TK. Secondary hypertension in overweight and stage 1 hypertensive children: a Midwest Pediatric Nephrology Consortium report. J Clin Hypertens (Greenwich) 2010;12:34-9. https://doi.org/10.1111/j.1751-7176.2009.00195.x
  15. Baracco R, Kapur G, Mattoo T, Jain A, Valentini R, Ahmed M, et al. Prediction of primary vs secondary hypertension in children. J Clin Hypertens (Greenwich) 2012;14:316-21. https://doi.org/10.1111/j.1751-7176.2012.00603.x
  16. Wirrell EC, Hamiwka LD, Hamiwka LA, Grisaru S, Wei X. Acute glomerulonephritis presenting with PRES: a report of 4 cases. Can J Neurol Sci 2007;34:316-21. https://doi.org/10.1017/S0317167100006740
  17. Strebel SP, Kindler C, Bissonnette B, Tschaler G, Deanovic D. The impact of systemic vasoconstrictors on the cerebral circulation of anesthetized patients. Anesthesiology 1998;89:67-72. https://doi.org/10.1097/00000542-199807000-00012
  18. Paulson OB, Strandgaard S, Edvinsson L. Cerebral autoregulation. Cerebrovasc Brain Metab Rev 1990;2:161-92.
  19. Cipolla MJ, Smith J, Kohlmeyer MM, Godfrey JA. SKCa and IKCa Channels, myogenic tone, and vasodilator responses in middle cerebral arteries and parenchymal arterioles: effect of ischemia and reperfusion. Stroke 2009;40:1451-7. https://doi.org/10.1161/STROKEAHA.108.535435
  20. Handa Y, Caner H, Hayashi M, Tamamaki N, Nojyo Y. The distribution pattern of the sympathetic nerve fibers to the cerebral arterial system in rat as revealed by anterograde labeling with WGA-HRP. Exp Brain Res 1990;82:493-8.
  21. Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996;334:494-500. https://doi.org/10.1056/NEJM199602223340803
  22. Hamilton BE, Nesbit GM. Delayed CSF enhancement in posterior reversible encephalopathy syndrome. AJNR Am J Neuroradiol 2008;29:456-7. https://doi.org/10.3174/ajnr.A0926
  23. Smith SJ. EEG in the diagnosis, classification, and management of patients with epilepsy. J Neurol Neurosurg Psychiatry 2005;76 Suppl 2:ii2-7.
  24. Lee WJ, Yeon JY, Jo KI, Kim JS, Hong SC. Reversible cerebral vasoconstriction syndrome and posterior reversible encephalopathy syndrome presenting with deep intracerebral hemorrhage in young women. J Cerebrovasc Endovasc Neurosurg 2015;17:239-45. https://doi.org/10.7461/jcen.2015.17.3.239

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