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A 39-year-old black male who consulted with sudden and painless loss of vision in his right eye in the context of a hypertensive crisis. A history of essential arterial hypertension uncontrolled at home due to lack of therapeutic adherence and with target organ involvement: lacunar infarct, grade IV hypertensive retinopathy and left ventricular concentric hypertrophy. Renal function was normal, without albuminuria. The clinical picture was classified as non-arteritic ischaemic optic neuropathy after ruling out vascular, traumatic, infectious and autoimmune disease. The patient presented discrete improvement of the visual deficit with the control of blood pressure. From his history and complementary tests, it was concluded that the ischaemic optic neuropathy was due to malignization of his arterial hypertension., (Copyright © 2020 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.)

We present the case of a 34-year-old patient with severe head trauma and severe brain involvement. The patient deteriorated progressively and required several reinterventions for bleeding and brain herniation. We were consulted by neurosurgery due to irregular blood pressure control despite treatment with calcium antagonists. The patient had associated diaphoresis, tachypnoea and tachycardia, together with persistent high-grade fever with no microbiological evidence. Laboratory tests showed normal kidney function, with no proteinuria and no signs of left ventricular hypertrophy to suggest previous arterial hypertension. This led us to consider sympathetic hyperactivity syndrome as a first possible diagnosis due to severe neurological damage. In line with this suspicion, antihypertensive therapy was initiated which included non-cardioselective beta-blockers, alpha-2 agonists, benzodiazepines and GABA receptor agonists. Thus, we were able to improve the labile blood pressure levels, which supports the diagnosis., (Copyright © 2020 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.)