Hypertensive Brainstem Encephalopathy Without Parieto-occipital Lesion —Two Case Reports—

Yoshimitsu DOI; Fumiharu KIMURA; Tohru FUJIYAMA; Chieko FUJIMURA; Takuya NISHINA; Toshihiko SATO; Takafumi HOSOKAWA; Hideaki UEHARA; Simon ISHIDA; Toshiaki HANAFUSA

doi:10.2176/nmc.46.75

Case Reports

Hypertensive Brainstem Encephalopathy Without Parieto-occipital Lesion

—Two Case Reports—

Yoshimitsu DOI, Fumiharu KIMURA, Tohru FUJIYAMA, Chieko FUJIMURA, Takuya NISHINA, Toshihiko SATO, Takafumi HOSOKAWA, Hideaki UEHARA, Simon ISHIDA, Toshiaki HANAFUSA

Author information

Yoshimitsu DOI
Division of Neurology, The First Department of Internal Medicine, Osaka Medical College
Fumiharu KIMURA
Division of Neurology, The First Department of Internal Medicine, Osaka Medical College
Tohru FUJIYAMA
Division of Neurology, The First Department of Internal Medicine, Osaka Medical College
Chieko FUJIMURA
Division of Neurology, The First Department of Internal Medicine, Osaka Medical College
Takuya NISHINA
Division of Neurology, The First Department of Internal Medicine, Osaka Medical College
Toshihiko SATO
Division of Neurology, The First Department of Internal Medicine, Osaka Medical College
Takafumi HOSOKAWA
Division of Neurology, The First Department of Internal Medicine, Osaka Medical College
Hideaki UEHARA
Division of Neurology, The First Department of Internal Medicine, Osaka Medical College
Simon ISHIDA
Division of Neurology, The First Department of Internal Medicine, Osaka Medical College
Toshiaki HANAFUSA
Division of Neurology, The First Department of Internal Medicine, Osaka Medical College

Keywords: reversible posterior leukoencephalopathy syndrome, posterior reversible encephalopathy syndrome, malignant hypertension, brainstem swelling, crescentic glomerulonephritis

JOURNAL OPEN ACCESS

2006 Volume 46 Issue 2 Pages 75-79

DOI https://doi.org/10.2176/nmc.46.75

Details

Abstract

Two patients presented with malignant hypertension associated with encephalopathy predominantly manifesting as brainstem lesion. T₂-weighted and fluid-attenuated inversion recovery magnetic resonance (MR) imaging revealed diffuse hyperintense areas in the pons and scattered lesions in the cerebellum, basal ganglia, and cerebral subcortex without parieto-occipital lesions. Diffusion-weighted MR imaging demonstrated these lesions as normal intensity, indicating vasogenic edema. These lesions resolved rapidly once hypertension was controlled. Review of clinical findings for 14 other patients with hypertensive brainstem encephalopathy without parieto-occipital lesions suggested that anterior circulation structures supplied by the carotid artery are frequently involved in such patients.

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