Abstract P072: Hypertensive Emergency Presenting With Intraventricular Hemorrhage

• Published in: Hypertension (Dallas, Tex. 1979) Tex. 1979), 2020-09, Vol.76 (Suppl_1)
• Main Authors: Kaplan, Jason G, Kanwal, Arjun, Bykowski, Adam, Berquist, John, Mirocke, Andrew, Dickey, John Q
• Format: Article
• Language: English
• ISSN: 0194-911X; 1524-4563
• DOI: 10.1161/hyp.76.suppl_1.P072

Abstract only A 34-year-old African American female with a past medical history of hypertension and medical noncompliance presented to the emergency department after being found down and unresponsive by her son. On presentation, the patient's blood pressure was found to be 298/194 with a Glasgow coma score of 4, with decerebrate posturing. The computed tomography of the head showed large acute intraventricular hemorrhage in the right lateral ventricle extending along the frontal horn into the left lateral ventricle, third and fourth ventricles, causing a 4 mm leftward shift. The patient was managed with a Nicardipine drip and underwent a bilateral ventriculostomy placement, which improved the patient's neurologic status. Following a 24 day hospital stay, the patient was alert and oriented without any significant neurologic deficits and discharged to a subacute rehab facility. Hypertension is one of the most common medical conditions affecting 50 million people in the United States and approximately 1 billion people worldwide. Approximately 1% of patients with hypertension will have a hypertensive emergency at some point in their life. The clinical manifestations of hypertensive emergencies are seen with organ dysfunction, which typically require diastolic blood pressures greater than 130mmHg, in nonpregnant adults. A severe outcome of hypertensive emergency is an intracerebral hemorrhage. In these patients, when the bleed extends into the ventricles, the mortality ranges from 50-80%. One study examined medical compliance in hypertensive patients, which showed approximately 40% of patients discontinued treatment one year after initiation of their antihypertensive medication and 4% never initiated therapy. This case illustrates the importance of compliance in hypertensive patients, as well as the dramatic ramifications that can occur with uncontrolled hypertension leading to hypertensive emergency.