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Convulsions and hypertension in children: differentiating cause from effect
F Proulx1, J Lacroix, C A Farrell
1Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Canada.
Insights
Blood pressure elevation can indicate hypertensive crisis or seizures. A blood pressure reading 4 standard deviations above the mean in postictal patients strongly suggests hypertensive crisis requiring treatment.
Area of Science:
- Pediatric Intensive Care
- Neurology
- Cardiology
Background:
- Hypertensive crisis and seizures can both cause elevated blood pressure (BP) in children.
- Differentiating the cause of BP elevation is crucial for appropriate management.
Purpose of the Study:
- To determine if the magnitude of BP increase can distinguish between convulsions due to hypertensive crisis and those from primary convulsive disorders.
Main Methods:
- Retrospective analysis of children admitted to a pediatric intensive care unit.
- Comparison of BP in children with hypertensive crisis versus those with status epilepticus.
Main Results:
- Children in hypertensive crisis had significantly higher BP Z scores than those with status epilepticus (p < .0001).
- A postictal BP of ≥4.0 SD above the mean predicted hypertensive crisis with 78% probability.
- A postictal BP <4.0 SD below the mean excluded hypertensive crisis with 100% negative predictive value.
Conclusions:
- Both hypertensive crisis and status epilepticus can present with high BP in children.
- The magnitude of BP increase is a valuable clinical parameter to exclude hypertensive crisis in postictal patients.
Objective:
To determine if the magnitude of blood pressure (BP) increase could differentiate convulsion caused by a hypertensive crisis from a primary convulsive disorder, which itself increases BP.
Design:
Retrospective analysis.
Setting:
Admission to a pediatric intensive care unit (ICU) within a tertiary care center.
Patients:
All children with hypertensive crisis admitted to the pediatric ICU from 1976 to 1990 were studied. Thirty-eight episodes occurred in 36 patients. The charts of children admitted for status epilepticus from 1976 to 1986 were also reviewed. One hundred and fifty-three episodes occurred in 145 patients.
Measurements And Main Results:
BP values at entry to the pediatric ICU in patients with hypertensive crisis were compared with the highest BP values obtained within an hour after cessation of convulsion in 120 patients admitted for status epilepticus. The Z scores for BP, adjusted for age and sex, were compared. The BP values for children in hypertensive crisis with or without convulsions were by far greater than the BP values observed in patients in status epilepticus (p < .0001). For a patient in the postictal phase, a BP > or = 4.0 SD above the mean for age and sex predicted with 78% probability the presence of a hypertensive crisis requiring emergency treatment. If the BP was < 4 SD below the mean, the possibility of a hypertensive crisis was excluded (negative-predictive value 100%).
Conclusions:
Children with hypertensive crisis, as well as children with status epilepticus, can present with a high BP. In a postictal patient, the magnitude of BP increase is a useful clinical parameter to exclude a hypertensive crisis that requires specific treatment of the BP.