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Brain Edema and Hypertensive Urgency 

Brain Edema and Hypertensive Urgency
Brain Edema and Hypertensive Urgency
Neurocritical Care (2 ed.)

Eelco F. M. Wijdicks

, Alejandro A. Rabinstein

, Sara E. Hocker

, and Jennifer E. Fugate


Posterior reversible encephalopathy syndrome (PRES) is encountered in a variety of clinical situations but most commonly in patients who are in a hypertensive crisis. Diagnosis of PRES should be considered in patients presenting with acute onset of headache, encephalopathy, seizure, or focal neurological deficits in the setting of blood pressure fluctuations, renal failure, cytotoxic drug use, autoimmune disorders, or eclampsia. Lowering the blood pressure gradually is often all that is needed. Complications involving seizures, hemorrhagic or ischemic strokes, and rarely hydrocephalus may require specific treatment. Without treatment or removal of the inciting trigger patients may progress to coma and status epilepticus.

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