The hypertonic crisis and its treatment

1. Big picture

A hypertonic crisis means a sudden, marked elevation of blood pressure. In neurology, the dangerous question is not only “How high is the blood pressure?” but:

Is there acute target-organ damage, especially brain involvement?

The most important neurological complications are:

• Hypertensive encephalopathy

• Intracerebral hemorrhage

• Subarachnoid hemorrhage worsening

• Posterior reversible encephalopathy syndrome, PRES

• Worsening of acute ischemic stroke if BP is lowered too aggressively

The key exam sentence:

In hypertensive crisis with neurological symptoms, lower blood pressure carefully and gradually; sudden pronounced reduction can worsen cerebral perfusion and cause ischemia.

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