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Hypertensive encephalopathy with predominant brain stem involvement: MRI findings

Journal of Human Hypertension volume 18, pages 133–134 (2004)Cite this article

Hypertensive encephalopathy is an acute and severe disorder that develops typically in patients with malignant hypertension or eclampsia and has also been reported in patients on immunosuppressive drug therapy. There are associated rapidly progressive symptoms from CNS involvement, such as headache, altered mental status, seizures or visual disturbances.1 Although the clinical findings are nonspecific, the findings on MRI are quite characteristic due to the pattern of the lesions which predominantly involve the supratentorial white matter, especially in the occipital lobes, as well as the brain stem and cerebellum.2 In our case, the MRI findings showed that the parietal and occipital lobes were minimally and moderately involved, respectively, while extensive lesions were seen within the cerebellum and medulla oblongata. Two different mechanisms have been proposed to explain the pathophysiology of hypertensive encephalopathy.3 The first theory suggests that acute hypertension causes cerebral vasculature vasospasm followed by a decrease in blood flow and intravascular thrombosis. These two factors seem to cause ischaemia and cytotoxic oedema. The second theory suggests that a sudden elevation of blood pressure produces a breakdown on autoregulation of cerebral vessels causing an extravasation of fluid into the surrounding brain tissue and inducing a reversible vasogenic oedema.4,5

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Authors and Affiliations

  1. Department of Radiology, University Hospital of Heraklion, Crete, Greece

    S K Karampekios, E Contopoulou & N Gourtsoyiannis

  2. Department of Neurology, University Hospital of Heraklion, Crete, Greece

    M Basta & M Tzagournissakis

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  1. S K Karampekios
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  2. E Contopoulou
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  3. M Basta
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  4. M Tzagournissakis
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  5. N Gourtsoyiannis
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Correspondence to S K Karampekios.

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Karampekios, S., Contopoulou, E., Basta, M. et al. Hypertensive encephalopathy with predominant brain stem involvement: MRI findings. J Hum Hypertens 18, 133–134 (2004). https://doi.org/10.1038/sj.jhh.1001654

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  • DOI: https://doi.org/10.1038/sj.jhh.1001654

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