J Korean Neurosurg Soc.  2013 Aug;54(2):139-141. 10.3340/jkns.2013.54.2.139.

Hypertensive Encephalopathy with Reversible Brainstem Edema

• Lee S
• Cho BK
• Kim H

• KMID: 1814253
• DOI: http://doi.org/10.3340/jkns.2013.54.2.139

Abstract

Presented here is a 36-year-old male with arterial hypertension who developed brainstem edema and intracranial hemorrhage. Magnetic resonance scan revealed diffuse brainstem hyperintensity in T2-weighted and fluid-attenuated inversion-recovery images, with an increase in apparent diffusion coefficient values. After a reduction in blood pressure, rapid resolution of the brainstem edema was observed on follow-up. The patient's condition was thus interpreted as hypertensive brainstem encephalopathy. While many consider this a vasogenic phenomenon, induced by sudden, severe hypertension, the precise mechanism remains unclear. Prompt recognition and aggressive antihypertensive treatment in such patients are essential to prevent permanent or life-threatening neurologic injury.

Keyword

Brain stem; Edema; Encephalopathy; Hypertension

MeSH Terms

Adult
Blood Pressure
Brain Stem
Diffusion
Edema
Follow-Up Studies
Humans
Hypertension
Hypertensive Encephalopathy
Intracranial Hemorrhages
Magnetics
Magnets
Male

Figure

• 

  Fig. 1 Axial CT image of brain showing intracranial hemorrhage of left basal ganglia with brainstem hypodensity (A and B).

• 

  Fig. 2 Axial MRI T2 and fluid-attenuated inversion recovery image showing increased signal intensity of pons and midbrain (A and B) : increase in apparent diffusion coefficient values for same area (C) and there are no abnormal findings in subcortical white matter of the parietal and occipital lobes other than the small amount of basal ganglia (D). MRI and diffusion-weighted images after blood pressure stabilization; note resolution of prior brainstem abnormalities (E and F).

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