Microsoft Word - NEF222BF


Masakazu Washio, MD, 2nd Department of Internal Medicine, Faculty of Medicine, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812 (Japan) Dear Sir, It has been reported that autopsy findings of patients who died of malignant hypertension (MHT) demonstrated increased brain weight, flattened gyri, and compressed ventricles [1]. Hypertensive encephalopathy sometimes develops during the course of renal diseases [1]. It is often difficult to decide upon the relative significance of uremia and hypertension per se in the genesis of symptoms of MHT associated with uremia [2]. The presented patient had hydrocephalus which was associated with MTH and renal failure and cured by antihyperten-sive therapy and dialysis treatment. A 25-year-old male with a history of glomerulonephritis was admitted to the Fukuoka Red Cross Hospital on June 21, 1988, because of MHT, renal failure, and unconsciousness. On June 13, 1988, he noticed headache. On the next day, he developed blurred vision. On June 19, he was admitted to another hospital because of severe headache, nausea, and vomiting. The blood pressure was 244/178 mm Hg. On June 20, he became delirious. Computed tomography (CT) scanning of his brain showed no hemorrhage but flattened gyri and dilated ventricles (fig. 1A-C). Blood chemistry showed elevations in blood urea nitrogen and creatinine (101 and 13.6 mg/dl, respectively). On June 21, he became somnolent and was transferred to our institution. On admission he was drowsy. The blood pressure was 248/130 mm Hg. Ophthalmological investigation showed round pupils and retinal hemorrhage and papilledema bilaterally. Chest and abdomen were normal. The tendon reñexes of the extremities were symmetrical, and no abnormal reflexes were found. The white blood cell count was 16,800/mm3, hemoglobin 12.2 g/dl, blood urea nitrogen 129 mg/dl, and creatinine 15 mg/dl. Peritoneal dialysis was started on June 21, the day of admission to our institution. With 10 mg of nifedipine four times daily and peritoneal dialysis, the blood pressure fell, and the disturbance of consciousness improved; the patient became alert on the 3rd hospital day. On the 4th hospital day, nifedipine was decreased from 10 mg four times daily to 10 mg twice daily and 100 mg of atenolol was added. Following atenolol treatment, the blood pressure remained at 140–170/70–

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@inproceedings{Nephron2008MicrosoftW, title={Microsoft Word - NEF222BF}, author={Nephron and M. Masakazu Washio and Fumiaki Maehara and Yoshiaki Takeno}, year={2008} }