IS HEADACHE AT ADMISSION ASSOCIATED WITH HIGHER RATE OF RECENT BRAIN MRI INJURY DURING MALIGNANT HYPERTENSION CRISIS?. (June 2022)

• Record Type: Journal Article
• Authors: Boulestreau, Romain; Tillement, Jeremie; Lucas, Ludovic; Cremer, Antoine; Doublet, Julien; Rubin, Sebastien; Sibon, Igor; Gosse, Philippe
• Is Part Of: Journal of hypertension. Volume 40(2022)Supplement 1
• Page Start: e297
• Page End: e298
• Publication Date: 2022-06
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000838616.59329.d2
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: Reliable clinical signs associated with recent brain injuries in neurologically asymptomatic patients during malignant hypertension crisis are lacking. We aimed to compare the prevalence of brain MRI injuries between fully asymptomatic patients and those with isolated headache. Design and method: This single-center, cross-sectionnal observational study recruited patients with malignant Hypertension (MHT). MHT was defined by severe hypertension and severe hypertensive retinopathy OR subacute damage of three among the target organs: heart, kidney, brain, vessels (thrombotic microangiopathy). Patients under 18 years old, under chronic dialysis and not willing to participate were excluded. IBrain MRI was performed within 21 days following diagnosis and was reviewed by a stroke neurologist who recorded the following markers: acute ischemic stroke(DWI and FLAIR positive), acute intracerebral hemorrhage (T2* and FLAIR positive), acute brain edema with extensive posterior white matter hyperintensity suggesting a PRES, and small vessel disease including old lacunar infarct, white matter hyperintensities (WMH), presence of dilated perivascular spaces. Primary endpoint was the prevalence of recent brain injury in both group. Results: 92 patients were included. Among them, the average age was 47.8 years, 67 % were men, average admission systolic blood pressure and diastolic blood pressure were respectively 213 +/- 31 mmHg and 119 +/- 19 mmHg, 73 % had severe hypertensive retinopathy, median(IQR) creatininemia was 115 (92–180) mol/l and 11 % had systemic Hemolysis. Patients with no clinical symptoms or isolated headache presented respectively 39.5 % and 40 % of recent brain MRI abnormalities (cerebral Hematoma, ischemic stroke or PRES, p = 0.96). Patients with neurological signs on admission tended to have a higher frequency of recent brain injury than patients with isolated headaches (64, 5%, p = 0, 06), and a higher prevalence of chronic lacunar infarct (70, 5% vs 44%, p = 0, 04). We found no difference regarding cerebral microangiopathy in the 3 groups. Conclusions: Prevalence of recent brain injuries among patients with isolated headache and fully asymptomatic patients at admission of malignant hypertensive patients are similar and high. This raises the question of systematically performing brain MRI in patients with malignant hypertensive crisis.