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Boulestreau R, Lucas L, Cremer A, et al. Neurologically asymptomatic patients frequently present cerebral injuries during malignant hypertension: a MRI study. J Hypertens. 2021;39(12):2463-2469doi: 10.1097/HJH.0000000000002950.
Boulestreau, R., Lucas, L., Cremer, A., Debeugny, S., Rubin, S., Gaudissard, J., Doublet, J., Sibon, I., & Gosse, P. (2021). Neurologically asymptomatic patients frequently present cerebral injuries during malignant hypertension: a MRI study. Journal of hypertension, 39(12), 2463-2469. https://doi.org/10.1097/HJH.0000000000002950
Boulestreau, Romain, et al. "Neurologically asymptomatic patients frequently present cerebral injuries during malignant hypertension: a MRI study." Journal of hypertension vol. 39,12 (2021): 2463-2469. doi: https://doi.org/10.1097/HJH.0000000000002950
Boulestreau R, Lucas L, Cremer A, Debeugny S, Rubin S, Gaudissard J, Doublet J, Sibon I, Gosse P. Neurologically asymptomatic patients frequently present cerebral injuries during malignant hypertension: a MRI study. J Hypertens. 2021 Dec 01;39(12):2463-2469. doi: 10.1097/HJH.0000000000002950. PMID: 34343146.
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J Hypertens. 2021 Dec 01;39(12):2463-2469. doi: 10.1097/HJH.0000000000002950.

Neurologically asymptomatic patients frequently present cerebral injuries during malignant hypertension: a MRI study.

Journal of hypertension

Romain Boulestreau, Ludovic Lucas, Antoine Cremer, Stéphane Debeugny, Sébastien Rubin, Julie Gaudissard, Julien Doublet, Igor Sibon, Philippe Gosse

Affiliations

  1. Cardiological Department, Blood Pressure Clinic, Pau Hospital, Pau.
  2. INI-CRCT.
  3. Bordeaux University Hospital, Hypertension Excellence Center, Bordeaux.
  4. Bordeaux University Hospital, Stroke Center.
  5. Pau Hospital, Biostatistic and Clinical Research Unit, Pau.
  6. Nephrology Department, Bordeaux University Hospital.
  7. INSERM, Unit 1034, Bordeaux, France.

PMID: 34343146 DOI: 10.1097/HJH.0000000000002950

Abstract

BACKGROUND: Acute and diffuse microvascular damage characterizes malignant hypertension (MHT), the deadliest form of hypertension (HTN). Although its ophthalmological, renal and cardiological repercussions are well known, brain involvement is considered rare with few descriptions, although it is one of the main causes of death. We hypothesized that brain MRI abnormalities are common in MHT, even in patients without objective neurological signs.

METHOD: We analyzed retrospectively the brain MRI of patients admitted for acute MHT between 2008 and 2018 in Bordeaux University Hospital, regardless of their neurological status. A trained operator analyzed every brain MRI, looking for posterior reversible encephalopathy syndrome (PRES), ischemic stroke, intracerebral hematoma (ICH) and microangiopathy markers. We included 58 patients without neurological signs, 66% were men, and mean age was 45.6 ± 11.3 years.

RESULTS: Brain MRI were normal in 26% of patients but we found at least one acute abnormality on brain MRI in 29% and an Small Vessel Disease score (SVD score) of two or higher in 52%. In patients with neurological signs, these findings were 9, 53 and 70%, respectively. A PRES was found in 16% of asymptomatic patients and 31% had an ischemic stroke and/or a cerebral hematoma.

CONCLUSION: PRES, recent hematoma, ischemic stroke and severe cerebral microangiopathy are common findings in MHT patients without neurological signs on admission. The impact of these findings on patient management, and their cerebrovascular and cognitive prognostic value, should be established. Brain MRI might need to become systematic in patients suffering from MHT episodes.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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