Background and Purpose: Acute blood pressure elevations lead to wide spectrum of neurologic manifestations, ranging from no overt neurologic symptoms to catastrophic events like ICH. Little is known regarding the determinants of this clinical variability. We determined clinical and imaging features of hypertensive crisis patients with normal neurological examination, ICH and posterior reversible encephalopathy syndrome (PRES).Methods: Cranial MRI was performed in patients with hypertensive urgency or emergency but normal neurological examination. Their clinical characteristics, and imaging features regarding cerebral small vessel disease were compared to ICH and PRES patients.Results: Hypertensive ICH patients (n = 58) were older, less likely to have hyperlipidemia, less commonly used calcium channel blockers, and had higher burden of chronic cSVD features in comparison to hypertensive crisis patients with normal neurological findings (n = 51). Multivariate analyses revealed cSVD burden score (p = 0.003) to be related with ICH, while higher admission blood pressure levels (p < 0.001), hyperlipidemia (p = 0.006) and calcium channel blocker usage (p = 0.005) were more common in patients with normal neurological examination. The PRES (n = 9) group was comprised of younger patients with recent history of hypertension and low burden of cSVD.Conclusions: Hypertensive surge is associated with ICH when cSVD burden is high, probably caused by microvascular dysfunction secondary to long-standing hypertension, while the episode causes no structural damage if this burden is less. Although our observations are exploratory, short term but severe hypertension manifests with PRES possibly due to the absence of adaptive changes.

中文翻译：

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急性高血压危机期间神经系统表型的决定因素-一项初步研究。

背景与目的：急性血压升高会导致广泛的神经系统表现，范围从无明显的神经系统症状到诸如ICH的灾难性事件。关于这种临床变异性的决定因素知之甚少。我们确定了具有正常神经系统检查，ICH和后可逆性脑病综合征（PRES）的高血压危重患者的临床和影像学特征。方法：对患有高血压紧急情况或紧急情况但神经系统检查正常的患者进行颅MRI检查。将他们的临床特征和有关脑小血管疾病的影像学特征与ICH和PRES患者进行了比较。结果：高血压ICH患者（n = 58）年龄较大，高血脂的可能性较小，钙通道阻滞剂的使用较少，与神经系统检查结果正常的高血压危象患者相比，慢性cSVD特征的负担更高（n = 51）。多变量分析显示cSVD负担评分（p = 0.003）与ICH相关，而较高的入院血压水平（p <0.001），高脂血症（p = 0.006）和钙通道阻滞剂的使用（p = 0.005）神经系统检查正常。PRES（n = 9）组由近期有高血压病史和cSVD负担低的年轻患者组成。结论：当cSVD负担高时，高血压激增与ICH相关，可能是由长期高血压继发的微血管功能障碍引起的，如果负担减轻，则事件不会对结构造成损害。尽管我们的观察是探索性的，