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[Neurologic manifestations of arterial hypertension in children]
P Cochat1, M C Delmas, L de Parscau
1Unité de néphrologie, Hôpital Edouard-Herriot, Lyon, France.
Insights
Malignant hypertension in children, often linked to kidney disease, can cause severe neurological issues like seizures and vision problems. Early detection and treatment are crucial to prevent lasting neurological damage and improve outcomes.
Area of Science:
- Pediatric Nephrology
- Pediatric Neurology
- Cardiovascular Research
Background:
- Arterial hypertension in children is a growing concern, with renal and renovascular diseases being primary causes.
- Malignant hypertension, a severe form, can be the initial presentation of underlying renal pathology in pediatric patients.
- Neurological complications significantly impact the morbidity associated with childhood hypertension.
Purpose of the Study:
- To analyze the spectrum and outcomes of neurological complications in children with arterial hypertension.
- To investigate the association between renal/renovascular diseases and the incidence of malignant hypertension and its neurological sequelae.
- To highlight the importance of timely diagnosis and intervention for pediatric hypertension.
Main Methods:
- Retrospective analysis of 31 pediatric patients diagnosed with neurological complications of arterial hypertension.
- Evaluation of presenting symptoms, blood pressure readings, neurological examinations, electroencephalography (EEG), and neuroradiologic findings.
- Assessment of treatment responses, renal function, and neurological sequelae during follow-up.
Main Results:
- The study included 31 children (mean age 9 years) with arterial hypertension, predominantly due to renal/renovascular disease (58%).
- Neurological manifestations included seizures (48%), acute intracranial hypertension (39%), cranial palsy (23%), coma (19%), and hemiplegia/paresia (16%).
- Follow-up revealed hypertension resolution in 41%, renal function decline in 56%, and neurological sequelae in 40% of patients, with one mortality.
Conclusions:
- Neurological complications are a significant concern in pediatric arterial hypertension, particularly when secondary to renal disease.
- Early diagnosis and prompt treatment, including calcium channel blockers, are essential to mitigate severe neurological deficits and improve long-term outcomes.
- The high rate of neurological sequelae underscores the critical need for proactive management and prevention strategies for childhood hypertension.
Abstract:
Neurological complications of arterial hypertension are analyzed in 31 children (mean age = 9 years). All patients presented a renal or renovascular disease (acute nephritis + hypoplastic dysplasia , transplantation = 58%) for which malignant hypertension was the first symptom in 16%. The mean +/- SD initial blood pressure was 189 +/- 33/113 +/- 25 mm Hg and was preceded by previous symptoms in 1 patient out of 6. Neurological abnormalities consisted in seizures (48%), acute intracranial hypertension (39%), cranial palsy (23%), coma (19%), hemiplegia/paresia (16%), retinal changes (6%) or aphasia (6%). The EEG was abnormal in 50% of the patients, sometimes showing permanent paroxysmal activity. Neuroradiologic investigations revealed hemorrhagic and/or ischemic lesions in 1/5 patients. On follow-up, hypertension disappeared in 41% of the children; a decrease in renal function was noted in 56% of the patients at the last examination; neurological sequellae were present in 40% (EEG anomalies +/- epilepsy, motor deficit, retinal changes, psychomotor delay, cranial palsy) and 1 patient died. The morbidity of malignant hypertension stresses the importance of early diagnosis and treatment (calcium channel blockers) when its prevention is not possible.