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Related Concept Videos

Encephalitis l: Introduction01:19

Encephalitis l: Introduction

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Encephalitis is inflammation of the brain parenchyma, most often due to infections or autoimmune processes. It presents with neuropsychiatric features such as fever, altered mental status, behavioral changes, cognitive dysfunction, seizures, focal deficits, and sometimes autonomic instability. In some cases, the meninges are also involved, resulting in meningoencephalitis.Infectious CausesInfectious encephalitis is most commonly viral but can also result from bacterial, fungal, or parasitic...
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Increased Intracranial Pressure l: Introduction01:14

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Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component...
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Increased Intracranial Pressure ll: Pathophysiology01:29

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Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins...
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Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this...
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Cytotoxic Edema: Pathophysiology01:21

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Cytotoxic edema is a form of cerebral edema characterized by intracellular swelling of neurons, astrocytes, and other glial cells. It develops when the mechanisms responsible for maintaining ionic gradients across the cell membrane become impaired. Under normal physiological conditions, the sodium–potassium ATPase actively transports sodium ions out of the cell and potassium ions into the cell, preserving osmotic balance and enabling electrical signaling. This pump requires a continuous...
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Hepatic Encephalopathy01:29

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DefinitionHepatic encephalopathy is a reversible neurologic syndrome that results from advanced liver dysfunction or portosystemic shunting. It leads to disturbances in cognition, behavior, and motor function due to the brain’s exposure to gut-derived toxins that the liver fails to detoxify.EtiologyThis condition develops either in the setting of acute fulminant hepatitis or progressively during chronic liver disease, such as cirrhosis and portal hypertension. Portosystemic...
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Hypertensive Encephalopathy Triggered by Indomethacin Use.

Jane Plitman1, Vanessa Raco2, Peter E Wu1,3

  • 1Department of Medicine University of Toronto Toronto Canada.

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Summary

Indomethacin, a non-steroidal anti-inflammatory drug (NSAID), can trigger hypertensive encephalopathy in older adults with high blood pressure. Discontinuing the NSAID and managing hypertension resolved the patient's confusion and headaches.

Keywords:
acute medicinecardiovascular disordersemergency medicinegeneral medicinepharmacology and pharmacy

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Area of Science:

  • Neurology
  • Cardiology
  • Pharmacology

Background:

  • Hypertensive encephalopathy is a neurological condition characterized by acute confusion and elevated blood pressure.
  • Non-steroidal anti-inflammatory drugs (NSAIDs) can exacerbate underlying hypertension, particularly in elderly patients.
  • The renin-angiotensin-aldosterone (RAS) system plays a crucial role in blood pressure regulation, and its inhibition can increase susceptibility to NSAID-induced complications.

Purpose of the Study:

  • To report a case of hypertensive encephalopathy triggered by indomethacin in an elderly male patient.
  • To highlight the potential risks of NSAID use in patients with uncontrolled hypertension and those on RAS-inhibiting medications.
  • To emphasize the importance of careful patient evaluation before prescribing NSAIDs.

Main Methods:

  • Case report of a male patient in his 70s presenting with acute confusion.
  • Review of patient's medical history, including recent indomethacin prescription and existing hypertension treated with trandolapril.
  • Clinical examination, laboratory tests, and neuroimaging (CT and MRI) to rule out other causes.
  • Discontinuation of indomethacin and management of hypertension with amlodipine.

Main Results:

  • The patient presented with severe hypertension (190/110 mmHg) and acute confusion.
  • Laboratory and imaging studies were unremarkable for acute neurological processes or infections.
  • Following indomethacin discontinuation and blood pressure normalization, the patient's confusion and headaches resolved.
  • The patient was diagnosed with indomethacin-induced hypertensive encephalopathy.

Conclusions:

  • NSAID use, including indomethacin, can precipitate hypertensive encephalopathy, especially in patients with pre-existing hypertension.
  • Patients on anti-hypertensive medications that inhibit the RAS system are at higher risk for NSAID-related blood pressure decompensation.
  • Clinicians must carefully weigh the benefits against the risks of NSAIDs, considering the patient's overall health status and medication regimen.