Hypertensive brainstem encephalopathy: a diagnosis often overlooked.

Area of Science:

• Neurology
• Radiology
• Internal Medicine

Background:

• Hypertensive encephalopathy (HE) is a neurological condition typically affecting posterior brain regions.
• Isolated brainstem involvement in HE is exceptionally rare, with limited documented cases.

Observation:

• A case of acute hypertensive brainstem encephalopathy is presented.
• The patient exhibited severe hypertension with mild symptoms and a normal neurological exam.
• Brain imaging revealed diffuse hypodensity in the brainstem.

Findings:

• The patient showed significant clinical improvement upon hypertension management.
• A notable dissociation between clinical presentation and radiological findings was observed.
• These features strongly suggested hypertensive brainstem encephalopathy.

Implications:

• This case highlights the importance of recognizing rare presentations of HE, particularly brainstem involvement.
• Aggressive hypertension control is vital to prevent edema and potentially fatal progression.
• Increased physician and radiologist awareness is needed for this uncommon clinical entity.