Hypertensive encephalopathy is a life-threatening condition caused by a sudden rise in blood pressure, leading to the failure of cerebral autoregulation and vasogenic edema. Proper preoperative blood pressure management is essential for the prevention of perioperative complications, yet the inadequate control of hypertension remains a major cause of surgery cancellations. We report a 63-year-old man with a history of hypertension and poor medication adherence who was scheduled to undergo an elective tumor resection under general anesthesia. Despite presenting with severe hypertension (203/106 mmHg) on the day before surgery, a decision to proceed with the surgery was made under the assumption that intraoperative blood pressure control would be sufficient. Upon entering the operating room, however, the patient developed dizziness, tremors, and impaired consciousness, and a hypertensive crisis (277/131 mmHg) occurred. The surgery was canceled, and he was transferred to the ICU for blood pressure stabilization. A neurological evaluation confirmed hypertensive encephalopathy, and MRI findings suggested a high risk of cerebral hemorrhage. After aggressive antihypertensive therapy, his condition stabilized ; he was scheduled to undergo surgery three months later. This case underscores the importance of early therapeutic intervention in hypertensive patients undergoing elective surgery. An over-reliance on intraoperative blood pressure control can lead to severe complications. Strict adherence to antihypertensive therapy, a comprehensive preoperative evaluation, and interdisciplinary communication are crucial for preventing similar incidents and for ensuring patient safety.
