Brainstem Involvement in Hypertensive Encephalopathy: A Report of Two Cases and Literature Review

• Published in: European neurology Vol. 57; no. 4; pp. 223 - 226
• Main Authors: Uchino, Masafumi, Haga, Daisuke, Nomoto, Jun, Mito, Toshiaki, Kuramitsu, Tohru
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.01.2007
• Subjects: Adult; Blood Pressure - drug effects; Brain Stem - pathology; Cerebral Hemorrhage - diagnostic imaging; Confusion - etiology; Confusion - psychology; Headache - etiology; Humans; Hypertensive Encephalopathy - complications; Hypertensive Encephalopathy - diagnosis; Hypertensive Encephalopathy - drug therapy; Hypertensive Encephalopathy - physiopathology; Injections, Intravenous; Magnetic Resonance Imaging; Male; Nitroprusside - administration & dosage; Nitroprusside - therapeutic use; Original Paper; Tomography, X-Ray Computed; Vasodilator Agents - administration & dosage; Vasodilator Agents - therapeutic use; Verapamil - therapeutic use; Hypertension; Hypertensive encephalopathy, reversibility; Edema; Magnetic resonance imaging; Brainstem
• ISSN: 0014-3022; 1421-9913
• DOI: 10.1159/000100015

The cerebral hemispheres show prominent involvement in hypertensive encephalopathy far more frequently than the brainstem. Two patients with severe paroxysmally accelerated hypertension associated with brainstem hyperintensity in T 2 -weighted magnetic resonance images are presented. Both present hyperintense lesions improved dramatically in appearance after stabilization of blood pressure. Extreme acceleration of hypertension may be essential for breakdown of autoregulation in the brainstem circulation. The marked clinicoradiologic dissociation ruled out major brainstem infarction and made tumor unlikely.