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Hypertensive encephalopathy involving the brainstem and deep structures: a case report.
1Department of Neurology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan. csfong@tcts.seed.net.tw
Acta Neurologica Taiwanica
|January 24, 2006
Summary
Hypertensive encephalopathy can cause widespread brain edema, even in deep structures and the brainstem. Promptly controlling high blood pressure is crucial for symptom and lesion resolution.
Area of Science:
- Neurology
- Radiology
- Internal Medicine
Background:
- Hypertensive encephalopathy (HE) is a neurological emergency characterized by acute increases in blood pressure.
- It can lead to cerebral edema, but widespread white matter, deep structure, and brainstem involvement is rare.
Observation:
- An 80-year-old woman presented with severe hypertension, visual disturbances, headache, nausea, and vomiting.
- Magnetic resonance imaging (MRI) revealed extensive high signal intensity lesions in the cerebral white matter, cerebellum, basal ganglia, thalamus, and brainstem on T2-weighted and FLAIR sequences.
Findings:
- Diffusion-weighted imaging (DWI) MRI did not show restricted diffusion in these lesions, supporting vasogenic edema as the underlying pathology.
- The observed pattern of edema in HE, affecting deep structures and the brainstem, is an uncommon presentation.
Implications:
- This case highlights the diverse MRI manifestations of hypertensive encephalopathy.
- Effective management of hypertension is critical for reversing neurological symptoms and resolving cerebral edema in HE.