Review Question - QID 104145

The patient in this most likely suffering form hypertensive encephalopathy with a blood pressure >180/120 and signs of cerebral edema.

Hypertensive urgency is defined as a blood pressure of > 180/120 with no signs of acute end-organ damage. Hypertensive emergency is same blood pressure criterion with acute end-organ damage and can be further classified into: malignant hypertension = retinal hemorrhages, exudates and/or papilladema; hypertensive encephalopathy = cerebral edema and non-localizing neurologic signs/symptoms. It should be emphasized that hypertensive emergency does not only effect the CNS and/or eyes but can involve many organ systems, especially renal and cardiovascular. Other signs and symptoms to be aware of include epistaxis, hematuria, chest pain, and SOB.

Incorrect Answers:
Answer 1: A right MCA ischemic stroke would present with left facial paralysis, left arm paralysis, and difficulty speaking.
Answer 2: Central pontine myelinolysis presents as “locked-in sydrome” in which the patient is entirely paralyzed except for the eyelids.
Answer 4: Hypertensive urgency would have a blood pressure in this patient’s range but the patient would by definition be asymptomatic.
Answer 5: Alcohol withdrawal can present with hypertension, but we would expect to see an elevated heart rate as well as signs of sympathetic hyperactivation.