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Fortschr Neurol Psychiatr 2018; 86(05): 290-300
DOI: 10.1055/s-0043-122600
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Hypertensive Krise und posteriores reversibles Enzephalopathie-Syndrom (PRES)

Hypertensive crisis and posterior reversible encephalopathy syndrome (PRES)
Olaf Eberhardt
Klinikum Bogenhausen Klinik für Neurologie
› Author Affiliations
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Publication History

Publication Date:
28 February 2018 (online)

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Zusammenfassung

Die therapeutische Dringlichkeit der hypertensiven Entgleisung wird vorrangig vom Vorliegen von akuten neurologischen, okulären, kardiopulmonalen oder renalen Endorganschäden bestimmt. Ohne akute Endorganschäden (hypertensive urgency) ist in der Regel eine orale Behandlung mit dem Ziel der RR-Normalisierung über 24–48 h ausreichend. Bei gravierenden hypertensiven Organsymptomen (hypertensive emergency, hypertensiver Notfall) ist eine zügige intravenöse Initialtherapie erforderlich, bei der die Präparatewahl und das Blutdruckziel von der Organmanifestation und Begleiterkrankungen abhängig sind. Empfehlungen zur optimalen Blutdrucksteuerung bei akuten neurovaskulären Erkrankungen werden durch divergierende Studienergebnisse und die Vielfalt potentiell relevanter Parameter erschwert. Das breite Spektrum des posterioren reversiblen Enzephalopathie-Syndroms kann in atypischen Fällen die Diagnose erschweren. Clevidipin könnte in Zukunft eine willkommene Erweiterung der intravenösen Therapieoptionen auch für neurologische Patienten darstellen.

Abstract

The urgency and intensity of therapeutic response to a hypertensive crisis are governed by the presence or absence of acute end-organ damage, which define hypertensive emergency and hypertensive urgency, respectively. In case of hypertensive urgency a slow and moderate lowering of blood pressure by oral antihypertensive agents seems adequate, while the approach to hypertensive emergency has to be tailored to the specific type of organ failure. Optimal blood pressure management in the context of neurovascular emergencies is made difficult by contradictory data from observational and interventional studies. It might prove advantageous to individualize treatment according to characteristics such as the location of persistent vessel occlusion or the presence of collaterals. Reversible posterior encephalopathy may present with atypical features that might make diagnosis difficult. Clevidipine might be a welcome supplement to current intravenous antihypertensive agents in neurological disease.

Schlüsselwörter

Hypertonie - hypertensive Krise - Schlaganfall - Enzephalopathie - PRES

Key words

hypertension - hypertensive urgency - hypertensive emergency - stroke - encephalopathy - PRES
 

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