Convulsion, Hypertension

Abstract

There was a 16-year-old adolescent girl complaining of intermittent convulsions in 12 hours.Forty days before her admission, she fell from a building and had mental and behavioral disorders since then; she wound her left foot and got infected.After her admission, she had a fever, hypertension (blood pressure up to 25.3/16.7 kPa), and elevation of C-reactive protein (CRP). At the beginning of admission, there was a suspect that she had brain abscess because of her fever, elevated CRP and an infectious wound in left foot, and the high blood pressure might be attributed to the intracranial hypertension.But soon, it was found that the hypertension could not be explained by intracranial hypertension because she had no other signs of high intracranial pressure.Therefore, the hypertensive encephalopathy might be resulted in convulsions.The head magnetic resonance imaging diffusion weighted imaging displayed high signal mainly in the head including occipital, frontal and parietal lobes.These images were in accordance with posterior reversible encephalopathy and supported the diagnosis of hypertensive encephalopathy.Further examination for the cause of hypertension showed that her left kidney was small and functioned poorly, and the left renal artery was malformed.After antihypertensive and symptomatic treatment, the girl's condition was significantly improved.Her blood pressure became stable (11.3-15.9 kPa / 8.7-11.3 kPa). The lesions on head magnetic resonance imaging were significantly reduced.Conclusions: More attention should be paid on basal physical examination (such as measurement of blood pressure), and multidisciplinary collaboration should be emphasized and developed. Key words: Convulsion; Hypertension; Posterior reversible encephalopathy syndrome