Diagnosis of Malignant Hypertension with Ocular Examination: A Child Case

Yıldırım, Adnan; Türkçü, Fatih Mehmet; Yüksel, Harun; Şahin, Alparslan; Çınar, Yasin; Çaça, İhsan

doi:10.3109/08820538.2013.839812

Cited by 6 publications

(5 citation statements)

References 7 publications

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“…The ophthalmoscopic examination shows the presence of bilateral retinal haemorrhages and exudates, with or without papilledema (grade IV Keith-Wagener score), and the fluoroangiographic examination shows retinal oedema [32]. This clinical picture is independent of cardiovascular risk and is seen in young males with the severe and abrupt appearance of arterial hypertension in patients with pheochromocytoma [32][33][34].…”

Section: Hypertensive Retinopathy and Encephalopathymentioning

confidence: 83%

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Hypertensive Emergencies: a New Clinical Approach

Lagi

Cencetti

2014

J Hypertens

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The expression 'hypertensive urgencies' includes many diseases. The unifying features of these diseases are a high level of arterial pressure and acute distress of one or more organs. The aim of the review was to define the idea of the 'acute hypertension' as a new concept, different from 'chronic hypertension'. Acute hypertension might be related to 'organ damage' because it is the cause, the consequence or an effect of the acute stress. We compounded a narrative review which has included analyses of 373 articles. The structure of the search strategy included a literature search of PubMed, MEDLINE, Cochrane Library and Google Scholar databases. We applied the following inclusion criteria: prospective double-blind randomised controlled trials, experimental animal work studies, case-control studies and recruiting patients representative of the general sick population. In this review, the diseases included in the term 'hypertensive emergencies' share 'acute' hypertension. This is a new idea that emphasises the suddenly increased arterial pressure, irrespective of the initial arterial pressure and independent of the goals of hypertension control. The 'hypertensive emergencies' have been grouped together in three subsets: (1) diseases that result from acute hypertension that is caused by faulty regulation of the peripheral circulation (acute primary hypertension), (2) diseases that produce hypertension (acute secondary hypertension) and 3) diseases that have hypertension as an effect of the acute stress caused by the principle disease (acute associated hypertension). This review highlights a novel idea: acute hypertension is a common sign of different diseases characterised by the sudden surge of arterial pressure, so overwhelming the difference between hypertensive emergencies and urgencies. The judgment of acute hypertension is independent of the initial arterial pressure, normotension or hypertension and is linked with the transient failure of the baroreflex. Hypertensive emergencies are grouped together because all of these diseases require prompt therapy to prevent the negative outcomes of acute hypertension

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Section: Hypertensive Retinopathy and Encephalopathymentioning

confidence: 83%

“…This clinical picture is independent of cardiovascular risk and is seen in young males with the severe and abrupt appearance of arterial hypertension in patients with pheochromocytoma [32][33][34].…”

Section: Hypertensive Retinopathy and Encephalopathymentioning

confidence: 91%

Hypertensive Emergencies: a New Clinical Approach

Lagi

Cencetti

2014

J Hypertens

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“…We describe a case of hypertensive retinopathy grade 5, according to the classification of Keith et al [ 4 ] as a presenting sign in a 13-year-old child with malignant hypertension secondary to a left suprarenal pheochromocytoma [ 8 – 10 ]. It is known that hypertensive episodes associated with pheochromocytoma are produced by abnormally increased of sympathetic neuronal impulse frequency with excessive release of norepinephrine into the synaptic cleft with each impulse [ 1 , 6 ] and it seems that it can determinate an optic disc ischemical damage [ 4 , 5 , 10 ]. Because of the vascular injury, a rapid reduction of high BP should avoid and prevent optic atrophy and permanent vision loss [ 4 , 10 ] so they must be considered systemic emergencies.…”

Section: Discussionmentioning

confidence: 99%

“…MHT in children older than 10 years is characterized by two major features: severe increase in systolic blood pressure (BP), diastolic BP or both (≥170 mm Hg systolic and ≥110 mm Hg diastolic) [ 3 ], and hypertensive retinopathy grades 3 or 4 according to the classification of Keith et al [ 4 ]. Renal vascular diseases and primary hypertension are recognized as the main causes of pediatric hypertension in children older than 10 years [ 2 , 5 – 7 ], while pheochromocytomas are extremely rare conditions [ 1 , 2 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Hypertensive Retinopathy as a Presenting Sign of Pheochromocytoma with Malignant Hypertension: A Child Case

Billia,

Palmieri,

Maccari

et al. 2023

Case Rep Ophthalmol

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A 13-year-old was admitted to our clinic complaining about a vision loss of over 2 weeks. Bilateral optic disc edema, peripapillary flame-shaped hemorrhages, macular star pattern exudates, and cotton wool spots were found in fundoscopic examination. The OCT exam showed bilaterally serous retinal detachments in sub-foveal region with intraretinal exudates. A pediatric examination found a high systemic hypertension of 230/140 mm Hg, and laboratory tests revealed increased levels of plasmatic and urinary catecholamines. An abdominal MRI showed a left suprarenal pheochromocytoma and the child underwent an adrenalectomy urgently. Informed patient consent was obtained from legal guardians to publish clinical images. Malignant hypertension (MHT) as a result of a pheochromocytoma is an extremely rare condition in childhood. MHT crisis represents a potential life-threatening event and an immediate treatment can prevent a multi-organ failure, including the eyes. An early diagnosis of MHT by fundus examination can lead to a completely favorable ophthalmological evolution and entirely functional recovery.

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“…The ophthalmoscopic examination shows the presence of bilateral retinal haemorrhages and exudates, with or without papilledema (grade IV Keith–Wagener score), and the fluoroangiographic examination shows retinal oedema [ 32 ]. This clinical picture is independent of cardiovascular risk and is seen in young males with the severe and abrupt appearance of arterial hypertension in patients with pheochromocytoma [ 32 – 34 ].…”

Section: Reviewmentioning

confidence: 99%

Hypertensive emergencies: a new clinical approach

Lagi

Cencetti

2015

Clin Hypertens

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The expression ‘hypertensive urgencies’ includes many diseases. The unifying features of these diseases are a high level of arterial pressure and acute distress of one or more organs. The aim of the review was to define the idea of the ‘acute hypertension’ as a new concept, different from ‘chronic hypertension’. Acute hypertension might be related to ‘organ damage’ because it is the cause, the consequence or an effect of the acute stress. We compounded a narrative review which has included analyses of 373 articles. The structure of the search strategy included a literature search of PubMed, MEDLINE, Cochrane Library and Google Scholar databases. We applied the following inclusion criteria: prospective double-blind randomised controlled trials, experimental animal work studies, case–control studies and recruiting patients representative of the general sick population. In this review, the diseases included in the term ‘hypertensive emergencies’ share ‘acute’ hypertension. This is a new idea that emphasises the suddenly increased arterial pressure, irrespective of the initial arterial pressure and independent of the goals of hypertension control. The ‘hypertensive emergencies’ have been grouped together in three subsets: (1) diseases that result from acute hypertension that is caused by faulty regulation of the peripheral circulation (acute primary hypertension), (2) diseases that produce hypertension (acute secondary hypertension) and 3) diseases that have hypertension as an effect of the acute stress caused by the principle disease (acute associated hypertension). This review highlights a novel idea: acute hypertension is a common sign of different diseases characterised by the sudden surge of arterial pressure, so overwhelming the difference between hypertensive emergencies and urgencies. The judgment of acute hypertension is independent of the initial arterial pressure, normotension or hypertension and is linked with the transient failure of the baroreflex. Hypertensive emergencies are grouped together because all of these diseases require prompt therapy to prevent the negative outcomes of acute hypertension

show abstract

Diagnosis of Malignant Hypertension with Ocular Examination: A Child Case

Cited by 6 publications

References 7 publications

Hypertensive Emergencies: a New Clinical Approach

Hypertensive Emergencies: a New Clinical Approach

Hypertensive Retinopathy as a Presenting Sign of Pheochromocytoma with Malignant Hypertension: A Child Case

Hypertensive emergencies: a new clinical approach

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