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01-12-2013 | Case Report

Brainstem swelling and noncommunicating hydrocephalus caused by hypertensive brainstem encephalopathy

Authors: Nuri Karabay, Lale Emin, Emel Ada

Published in: Emergency Radiology | Issue 6/2013

Abstract

Hypertensive encephalopathy is a life-threatening medical condition manifested by headache, confusion, seizures, and visual disturbance, and, if treatment is delayed, it may progress to coma and death [1, 2] (Chester et al., Neurology 28:928–939, 1978; Vaughan and Delanty, Lancet 356:411–417, 2000). Involvement of the brainstem with or without supratentorial lesions has been reported and is termed hypertensive brainstem encephalopathy (HBE). Cases of HBE involving supratentorial deep gray and white matter are rare and extensive hyperintensity was predominantly seen in brainstem regions on fluid-attenuated inversion recovery and T2-weighted magnetic resonance images. We present radiologic findings of a patient with HBE involving deep supratentorial gray and white matter, causing tonsillar herniation and noncommunicating hydrocephalus by mass effect.

Chester EM, Agamanolis DP, Banker BQ, Victor M (1978) Hypertensive encephalopathy: a clinicopathologic study of 20 cases. Neurology 28:928–939PubMedCrossRef

Vaughan CJ, Delanty N (2000) Hypertensive emergencies. Lancet 356:411–417PubMedCrossRef

Schwartz RB (2002) Hyperperfusion encephalopathies: hypertensive encephalopathy and related conditions. Neurologist 8:22–34PubMedCrossRef

Garg RK (2001) Posterior leukoencephalopathy syndrome. Postgrad Med J 77:24–28PubMedCrossRef

Kumai Y, Toyoda K, Fujii K, Ibayashi S (2002) Hypertensive encephalopathy extending into the whole brainstem and deep structures. Hypertens Res 25:797–800PubMedCrossRef

Park JH, Kim SM, Shin HW, An SJ (2010) Hypertensive brainstem encephalopathy involving deep supratentorial regions: does only blood pressure matter? Neurol Int 2:e9PubMedCrossRef

Hauser RA, Lacey DM, Knight MR (1988) Hypertensive encephalopathy. Magnetic resonance imaging demonstration of reversible cortical and white matter lesions. Arch Neurol 45:1078–1083PubMedCrossRef

Karasawa S, Kawanami T, Kimura H, Kurita K, Kato T (2004) An unusual case of hypertensive encephalopathy involving the brain stem. Intern Med 43:448–449PubMedCrossRef

Ono Y, Manabe Y, Hamakawa Y, Murakami T, Omori N, Hayashi Y, Abe K (2005) Localized lesions on MRI in a case of hypertensive brainstem encephalopathy. Intern Med 44:1002–1005PubMedCrossRef

10.

Kanazawa M, Sanpei K, Kasuga K (2005) Recurrent hypertensive brainstem encephalopathy. J Neurol Neurosurg Psychiatry 76:888–890PubMedCrossRef

11.

Uchino M, Haga D, Nomoto J, Mito T, Kuramitsu T (2007) Brainstem involvement in hypertensive encephalopathy: a report of two cases and literature review. Eur Neurol 57:223–226PubMedCrossRef

12.

Kang SY, Choi JC, Kang JH (2007) Two cases of hypertensive encephalopathy involving the brainstem. J Clin Neurol 3:50–52PubMedCrossRef

13.

Shintani S, Hino T, Ishihara S, Mizutani S, Shiigai T (2008) Reversible brainstem hypertensive encephalopathy (RBHE): clinicoradiologic dissociation. Clin Neurol Neurosurg 110:1047–1053PubMedCrossRef

14.

Bhagavati S, Chum F, Choi J (2008) Hypertensive encephalopathy presenting with isolated brain stem and cerebellar edema. J Neuroimaging 18:454–456PubMedCrossRef

15.

de Seze J, Mastain B, Stojkovic T, Ferriby D, Pruvo JP, Destee A, Vermersch P (2000) Unusual MR findings of the brain stem in arterial hypertension. AJNR Am J Neuroradiol 21:391–394PubMed

16.

Yasuda Y, Akiguchi I, Imai T, Sonobe M, Kage M (2003) Hypertensive brainstem encephalopathy. Intern Med 42:1131–1134PubMedCrossRef

17.

Nagata M, Maeda M, Tsukahara H, Maier SE, Takeda K (2004) Brain stem hypertensive encephalopathy evaluated by line scan diffusion-weighted imaging. AJNR Am J Neuroradiol 25:803–806PubMed

18.

Fujiwara H, Momoshima S, Kuribayashi S, Sasamura H (2005) Hypertensive encephalopathy of brain stem with minimal supratentorial involvement: a rare manifestation of hypertensive encephalopathy. Radiat Med 23:504–507PubMed

19.

Yoshida K, Yamamoto T, Mori K, Maeda M (2001) Reversible posterior leukoencephalopathy syndrome in a patient with hypertensive encephalopathy—case report. Neurol Med Chir 41:364–369CrossRef

20.

Chang GY, Keane JR (1999) Hypertensive brainstem encephalopathy: three cases presenting with severe brainstem edema. Neurology 53:652–654PubMedCrossRef

21.

Hodnett P, Coyle J, O'Regan K, Maher MM, Fanning N (2009) PRES (posterior reversible encephalopathy syndrome), a rare complication of tacrolimus therapy. Emerg Radiol 16:493–496PubMedCrossRef

Title: Brainstem swelling and noncommunicating hydrocephalus caused by hypertensive brainstem encephalopathy
Authors: Nuri Karabay
Lale Emin
Emel Ada
Publication date: 01-12-2013
Publisher: Springer Berlin Heidelberg
Published in: Emergency Radiology / Issue 6/2013
Print ISSN: 1070-3004
Electronic ISSN: 1438-1435
DOI: https://doi.org/10.1007/s10140-013-1143-7

At a glance: The STEP trials

Springer Medicine

Brainstem swelling and noncommunicating hydrocephalus caused by hypertensive brainstem encephalopathy

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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