Hypertensive Emergencies Case 2

A 66-year-old woman is brought by ambulance to the ED with a 24 hour history of headache and confusion. She has a history of angina and hypertension and her prescription list is found in her handbag: aspirin, atenolol and bendroflumethazide and a GTN spray. There is no history of injury.

On examination she is restless and confused. Observations are as follows: P = 95, BP = 225/135, SaO2 = 96% on air, RR = 20, Temp is 37.4 degrees centigrade. Her GCS is 13/15. Her heart sounds are normal and her chest is clear upon auscultation. There is no focal neurological deficit.

Identify the three most important differential diagnoses related to intracranial pathology from the list below.

You organise an urgent CT scan which is normal and, in particular, reveals no evidence of subarachnoid haemorrhage. Her husband arrives and reports that, because she has not had any angina for over 12 months, she had decided to stop taking her medication during the previous month.

You consider that hypertensive encephalopathy is the most likely diagnosis and decide to bring her blood pressure under control. You decide to use intravenous sodium nitroprusside to achieve this aim. Her blood pressure is BP = 225/135.

What is her mean arterial blood pressure?

What is the goal for the mean arterial pressure one hour from commencement of treatment?