Acute hypertensive encephalopathy: findings on spin-echo and gradient-echo MR imaging

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Hypertensive encephalopathy is a neurological condition characterized by brain dysfunction due to severe hypertension.
• Distinguishing between reversible edema and irreversible infarction in hypertensive encephalopathy can be challenging.

Purpose of the Study:

• To investigate the findings on spin-echo and gradient-echo MRI in patients with hypertensive encephalopathy.
• To assess the utility of different MRI sequences in characterizing brain changes associated with hypertensive encephalopathy.

Main Methods:

• Prospective examination of MRI scans from 36 patients with acute hypertensive encephalopathy (< 72 hours).
• Assessment of brain swelling (short TR images), hyperintensity (long TR images), and hypointensity (long TR and gradient-echo images).

Main Results:

• Supratentorial white matter hyperintensity was common (n=32), indicating edema, infarction, or ischemic disease.
• Characteristic edema was observed in basal ganglia (n=22), brainstem (n=15), and cerebellum (n=11).
• Punctate hypointensities on gradient-echo images were a distinguishing feature, indicative of petechial hemorrhages.

Conclusions:

• MRI is effective in visualizing deep ganglionic and posterior fossa edema, typical of hypertensive encephalopathy.
• Serial MRI studies are needed to differentiate transient edema from permanent infarction.
• Gradient-echo MRI is valuable for detecting petechial hemorrhages, a marker distinguishing hypertensive encephalopathy from other white matter diseases.