J Korean Soc Radiol.  2014 Dec;71(6):314-319. 10.3348/jksr.2014.71.6.314.

Predominant Hypertensive Brainstem Encephalopathy with Supratentorial Involvement: Case Report and Literature Review

• Kim JH
• Park ST
• Lim HK
• Kim ST
• Cha J

• KMID: 1801555
• DOI: http://doi.org/10.3348/jksr.2014.71.6.314

Abstract

Hypertensive encephalopathy typically presents with bilateral parietooccipital vasogenic edema. Brainstem and cerebellar edema are uncommon in association with typical supratentorial changes. We experienced three cases of atypical hypertensive encephalopathy involving brainstem and cerebellum as well as cerebral white matter, which showed characteristic alternating linear bright and low signals in the pons, the so-called "stripe sign". We report these cases here with a brief literature review.

MeSH Terms

Brain Edema
Brain Stem*
Cerebellum
Edema
Hypertension, Malignant
Hypertensive Encephalopathy
Pons
Posterior Leukoencephalopathy Syndrome

Figure

• 

  Fig. 1 A 36-year-old female presented with headache. MR images showed hyperintensity involving the periventricular cerebral white matter (A), pons and cerebellum bilaterally, with the stripe sign in the pons on fluid-attenuated inversion recovery (FLAIR) images (B). Corresponding apparent diffusion coefficient map revealed increased diffusion in the brainstem (C). Follow-up MR images 3 weeks after initial MRI showed significant diminution of hyperintensity on FLAIR images.

• 

  Fig. 2 A 55-year-old female suffered from headache and vomiting. MR images showed symmetric hyperintensity in the periventricular cerebral white matter (A), brainstem and cerebellum on fluid-attenuated inversion recovery images with the stripe sign in the pons. The periphery of the pons was relatively spared (B).

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