Hypertensive brainstem encephalopathy with isolated headache and blurred vision: A case report

Headache with papilledema is a critical neurological symptom that necessitates prompt evaluation for underlying central nervous system pathology. While often associated with conditions such as aneurysmal subarachnoid hemorrhage, hypertensive emergencies can also present with similar features and require immediate management to prevent end-organ damage.

A 41-year-old man with no significant medical history presented with acute severe headache, vomiting, and blurred vision in the left eye. His blood pressure was markedly elevated at 200/130 mmHg. Fundoscopic examination revealed optic disc swelling, flame-shaped hemorrhages, and exudates in both eyes. Brain MRI demonstrated asymmetric hyperintensities in the brainstem, consistent with hypertensive brainstem encephalopathy (HBE). Lumbar puncture revealed elevated intracranial pressure without evidence of infection or hemorrhage. Blood pressure control with intravenous calcium channel blockers resulted in rapid symptom resolution, and subsequent antihypertensive therapy led to complete recovery of brainstem lesions and significant improvement in papilledema.

HBE can present with severe headache and papilledema but minimal neurological deficits despite striking MRI abnormalities. Early recognition through neuroimaging and prompt blood pressure management are crucial in preventing irreversible damage and optimizing patient outcomes.