Here is the answer to this weeks #USMLE Trivia Tuesdays question: Choice a is correct. The blood pressure of 212/126 indicates that this patient is suffering from a hypertensive emergency. Considering the presence of confusion and lethargy, one can also surmise that the patients condition has deteriorated to hypertensive encephalopathy. Under normal conditions, the cerebral blood flow is auto-regulated to maintain constant perfusion – that is, as blood pressure increases cerebral arterioles constrict to reduce flow and as blood pressure falls cerebral arterioles dilate to increase blood flow. However, in the setting of extreme hypertension mechanisms of cerebral autoregulation fail and arterioles dilate. This leads to diffuse edema and mental status changes. Choices d, e, and f are incorrect because this patient is suffering from hypertensive encephalopathy and thus autoregulatory mechanisms producing vasoconstriction with increased blood pressure have already failed. Choices b and e are incorrect because rather than suffering from too little blood flow producing ischemia, hypertensive encephalopathy is characterized by excessive blood flow resulting in edema. While hypertension is a risk factor for cerebral hemorrhage, choices c and f are inconsistent with the gradual onset and progression of symptoms in this patient. Intraparenchymal hemorrhage would likely be associated with focal neurologic deficits whereas subarachnoid hemorrhage is typically associated with a sudden onset severe headache.
Posted on: Thu, 06 Nov 2014 16:00:27 +0000
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