J Korean Pediatr Soc.  1998 Aug;41(8):1135-1139.

A Case of Cystic Encephalomalacia Developed after Hypertensive Encephalopathy

• Kim NY
• Cho SM
• Lee DS
• Kim DK
• Choi SM

Abstract

Encephalomalacia is a spongiform white matter change, which consists of rarefaction, vacuoles, larger cavities, and sometimes coalesces into cysts. We experienced a 14-year-old male with cystic encephalomalacia developed after cerebral infarction associated with hypertensive encephalopathy. Hypertensive encephalopathy is related to edema within the cerebral white matter. He visited another hospital because of generalized seizure, and his blood pressure was 180/100 mmHg. Nifedipine was given immediately, but seizure couldn't be controlled, so he was transferred to our hospital for further evaluation. When he arrived, his BP was 130/80mmHg. Initial laboratory findings were hematuria, proteinuria, decreased C3, and increased ASO. We diagnosed the encephalopathy as a complication of acute poststreptococcal glomerulonephritis. On the first day, hypodense lesion in white matter of left parietal lobe showed on the brain CT, suggesting cerebral edema. On the 20th day, there was strong enhancement in the same site, suggesting cerebral infarction on Gd-DTPA enhanced T1WI. After 7 months, on follow-up MRI scan, we found the encephalomalatic change. The cause of encephalomalacia was presumed to be a rapid lowering of BP in the initial treatment. We report this very rare case with a brief review of some related literatures.

Keyword

Cystic encephalomalacia; Hypertensive encephalopathy; Poststreptococcal glomerulonephritis

MeSH Terms

Adolescent
Blood Pressure
Brain
Brain Edema
Cerebral Infarction
Edema
Encephalomalacia*
Follow-Up Studies
Gadolinium DTPA
Glomerulonephritis
Hematuria
Humans
Hypertensive Encephalopathy*
Magnetic Resonance Imaging
Male
Nifedipine
Parietal Lobe
Proteinuria
Seizures
Vacuoles
Gadolinium DTPA
Nifedipine