Clinical and pathophysiologic features of cerebral hypertensive crisis

Aim. To specify clinical and pathophysiologic features and prognostic significance of cerebral hypertensive crisis.

Methods. The study involved 44 patients with cerebral hypertensive crisis, 53 people with coronary artery disease and 14 healthy volunteers. All patients underwent complete blood count and biochemical blood tests, vegetative status determination using questionnaire survey and recording heart rate variability parameters. In patients with cerebral hypertensive crisis systemic inflammation parameters (concentration of interleukin-6 and -8, C-reactive protein in the blood plasma) were determined. Catamnesis was specified by telephone interview.

Results. In cerebral hypertensive crisis, in contrast to coronary artery disease, the parasympathetic autonomic nervous system tone decreases, which is combined with inflammatory changes in the blood (increase in segmented leukocytes number and erythrocyte sedimentation rate), and an increase in the level of systemic inflammation markers: interleukin-6 and C-reactive protein. Vegetative regulation changes closely correlated with the inflammation level and the latter correlated with the clinical symptoms severity and determined poor prognosis in terms of recurrent transient episode. 90-day risk of ischemic stroke after cerebral hypertensive crisis was 2.3%.

Conclusion. In patients with cerebral hypertensive crisis the autonomic nervous system parasympathetic tone reduction combined with increased levels of inflammation markers in blood were revealed; adverse prognostic significance for recurrent ischemic attacks occurrence were leukocytes rate increase, band shift in leukocyte blood count, serum total calcium concentration reduction and blood plasma total protein level decrease.