J Korean Soc Magn Reson Med.  2014 Sep;18(3):258-262. 10.13104/jksmrm.2014.18.3.258.

Probable Isolated Hypertensive Brainstem Encephalopathy Combined with Intracerebral Hemorrhage: a Case Report

• Kim AY
• Seo HS
• Jeong SW
• Lee YS

• KMID: 1999926
• DOI: http://doi.org/10.13104/jksmrm.2014.18.3.258

Abstract

Hypertensive encephalopathy and basal ganglia intracerebral hemorrhage (ICH) are a medical emergency caused by a sudden elevation of systemic blood pressure. Although the relationship between hypertensive encephalopathy and large ICH has not been clarified yet, Cushing reflex in acute elevations of ICP due to large ICH may induce or aggravate hypertensive encephalopathy. We report a rare case of isolated hypertensive brainstem encephalopathy combined with hypertensive ICH.

Keyword

Magnetic resonance imaging; Hypertensive Encephalopathy; Cerebral Hemorrhage; Hypertension

MeSH Terms

Basal Ganglia
Blood Pressure
Brain Stem*
Cerebral Hemorrhage*
Emergencies
Hypertension
Hypertensive Encephalopathy
Magnetic Resonance Imaging
Reflex

Figure

• 

  Fig. 1 MR images at the time of admission. (a) Transverse T2-weighted and (b) T2*-gradient echo MR images at the basal ganglia show a large acute stage hemorrhage in the left basal ganglia with mild perilesional edema. Another small hemorrhage is noted in the right basal ganglia. There is no abnormal signal intensity in the parieto-occipital areas on the T2-weighted image. (c) Transverse T2-weighted MR and (d) FLAIR images at the pons show diffuse hyperintensity in the pons with sparing of the peripheral areas. (e) This lesion shows no abnormal signal intensity on diffusion-weighted image. (f) There is no enhancement on contrast enhanced T1-weighted image.

• 

  Fig. 2 Follow-up MR images on 6 days and 3 weeks later. (a) Transverse T2-weighted MR image on 6 days later shows an improved hyperintense lesion in pons but there is small residual patchy lesion. (b) Transverse T2-weighted MR image on 3 weeks later shows a complete improvement of pontine hyperintensity.

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