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Hypertensive encephalopathy: reversible CT and MR appearance
Y Katsumata1, T Maehara, M Noda
1Department of Radiology, Yokohama City University, School of Medicine, Japan.
Abstract:
The authors present a case of hypertensive encephalopathy in which CT and MR were performed. The brain stem and cerebellum were revealed as low density areas on CT and high intensity areas on T2-weighted MR images with mass effect. Slight abnormality was also noticed in the deep cerebral white matter. This distribution pattern is contrary to that described in previous reports in which cerebral white matter was mainly involved. The lesions showed definite improvement when the blood pressure was normalized. MR is more sensitive than CT, and is useful for early detection of the abnormality and follow-up study.
Insights
Hypertensive encephalopathy can affect the brain stem and cerebellum, differing from typical cerebral white matter involvement. Lesions improved with normalized blood pressure, highlighting MRI
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Hypertensive encephalopathy (HE) is a neurological condition characterized by symptoms like headache, seizures, and altered mental status, often associated with severe hypertension.
- Typical neuroimaging findings in HE often involve white matter lesions, particularly in the cerebral hemispheres.
Observation:
- A case study detailing imaging findings in a patient with hypertensive encephalopathy.
- Computed tomography (CT) revealed low-density areas in the brain stem and cerebellum.
- Magnetic resonance (MR) imaging, specifically T2-weighted sequences, showed high-intensity areas in the brain stem and cerebellum, accompanied by a mass effect.
Findings:
- The observed lesion distribution in the brain stem and cerebellum contrasts with previous reports primarily implicating cerebral white matter.
- Subtle abnormalities were also noted in the deep cerebral white matter.
- Imaging abnormalities demonstrated significant improvement following the normalization of blood pressure.
Implications:
- This case suggests a broader spectrum of imaging manifestations for hypertensive encephalopathy.
- Magnetic resonance imaging is more sensitive than CT for detecting HE-related abnormalities and is valuable for monitoring treatment response.
- Understanding atypical imaging patterns is crucial for accurate diagnosis and management of hypertensive encephalopathy.