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Hypertensive Encephalopathy (HE) is a clinical diagnosis and can look like many other disease entities.
HE refers to a relatively rapidly evolving syndrome of severe hypertension in association with severe headache, nausea, and vomiting, visual disturbances, convulsions, altered mental status and, in advanced cases, stupor and coma.
The key is the presence of severe hypertension. Remember, though, that 160/105 mm Hg may be high for an individual patient. Most patients with the syndrome will have diastolic pressures well in excess of 120-130 mm Hg. The only way you will know if the diagnosis is correct is to treat the BP (carefully control), work up other etiologies, and see of symptoms improve with BP control.
Beware the patient with severe HTN and seizure. Seizure may be the first, and only, symptom of hypertensive encephalopathy.