Clinical and radiological features of brainstem variant of hypertensive encephalopathy

The "posterior reversible leukoencephalopathy" syndrome, generally observed in the setting of severe, acute hypertension, often correlates with radiological abnormalities that involve the occipital lobes and other hemispheric areas. A predominant involvement of the brainstem in this syndrome is rare.

We report three patients with previously known or newly diagnosed severe hypertension, who presented with a combination of headache and visual disturbances, along with diffuse abnormalities demonstrated on magnetic resonance imaging in the brainstem and cerebellum. The absence of clinical features of brainstem or cerebellar dysfunction contrasted with the severity of the radiological abnormalities.

We discuss the pathophysiological, clinical, and radiographic features of this variant of posterior reversible leukoencephalopathy.