Department of Cardiology, University of Zurich, Zürich, Switzerland.
Department of Neurology, University of Zurich, Zürich, Switzerland.
J Feline Med Surg. 2023 Feb;25(2):1098612X231153357. doi: 10.1177/1098612X231153357.
Hypertensive encephalopathy in cats is an important entity but is underestimated in clinical practice. This could be explained, in part, by non-specific clinical signs. The objective of this study was to characterise the clinical manifestations of hypertensive encephalopathy in cats.
Cats with systemic hypertension (SHT) recognised by routine screening, associated with underlying predisposing disease or a clinical presentation suggestive of SHT (neurological or non-neurological), were prospectively enrolled over a 2-year period. Confirmation of SHT was based on at least two sets of measurements of systolic blood pressure >160 mmHg by Doppler sphygmomanometry.
Fifty-six hypertensive cats with a median age of 16.5 years were identified; 31 had neurological signs. In 16/31 cats, neurological abnormalities were the primary complaint. The other 15 cats were first presented to the medicine or ophthalmology service, and neurological disease was recognised based on the cat's history. The most common neurological signs were ataxia, various manifestations of seizures and altered behaviour. Individual cats also showed paresis, pleurothotonus, cervical ventroflexion, stupor and facial nerve paralysis. In 28/30 cats, retinal lesions were detected. Of these 28 cats, six presented with a primary complaint of visual deficits, and neurological signs were not the primary complaint; nine presented with non-specific medical issues, without suspicion of SHT-induced organ damage; in 13 cats, neurological issues were the primary complaint and fundic abnormalities were detected subsequently.
SHT is common in older cats and the brain is an important target organ; however, neurological deficits are commonly ignored in cats with SHT. Gait abnormalities, (partial) seizures and even mild behavioural changes should prompt clinicians to consider the presence of SHT. A fundic examination in cats with suspected hypertensive encephalopathy is a sensitive test to support the diagnosis.
猫的高血压性脑病是一种重要的病症，但在临床实践中被低估了。这在一定程度上可以解释为其非特异性的临床症状。本研究的目的是描述猫高血压性脑病的临床表现。
在 2 年的时间里，通过常规筛查发现患有系统性高血压（SHT）的猫，并伴有潜在的诱发疾病或有提示 SHT（神经或非神经）的临床表现。通过多普勒血压计至少两次测量收缩压>160mmHg 来确认 SHT。
共发现 56 只患有高血压的猫，中位年龄为 16.5 岁；31 只出现神经症状。在 16/31 只猫中，神经异常是主要的主诉。其他 15 只猫首先被介绍到内科或眼科就诊，根据猫的病史发现了神经疾病。最常见的神经症状是共济失调、各种癫痫发作表现和行为改变。个别猫还出现瘫痪、胸壁扭转、颈部腹侧弯曲、昏迷和面神经瘫痪。在 28/30 只猫中发现了视网膜病变。在这 28 只猫中，有 6 只猫以视力减退为主要主诉，神经症状不是主要主诉；9 只猫出现非特异性的医学问题，没有怀疑 SHT 引起的器官损伤；在 13 只猫中，神经问题是主要主诉，随后发现眼底异常。
SHT 在老年猫中很常见，大脑是一个重要的靶器官；然而，患有 SHT 的猫的神经缺陷通常被忽视。步态异常、（部分）癫痫发作甚至轻微的行为变化都应促使临床医生考虑 SHT 的存在。在疑似高血压性脑病的猫中进行眼底检查是支持诊断的敏感测试。
