Hypertensive encephalopathy mimicking cerebral vasculitis with pontine oedema, cerebellar white matter lesions and multiple cerebral infarctions.

Abstract

A 47-year-old man with poorly controlled hypertension presented with headaches, right-sided weakness and dysarthria. CT and MRI scans of the brain showed widespread abnormalities including significant pontine oedema, basal ganglia and corona radiata infarctions and cerebellar white matter high signal. Imaging of the intracerebral vasculature also demonstrated wall irregularities. Initially a central nervous system inflammatory disorder was thought to be the most likely diagnosis, possibly acute demyelinating encephalomyelitis or cerebral vasculitis, and the patient was treated with high-dose intravenous steroids. The diagnosis of hypertensive encephalopathy was made because (1) the patient was hypertensive and (2) the patients MRI findings resolved with antihypertensive treatment.Blood pressure treatment was instigated from admission, and the patients symptoms improved with resolution of the radiological abnormalities.

• Authors: Daniela Ceccarelli, David Hargroves, Ibrahim Balogun, Thomas Webb
• Journal: BMJ case reports (BMJ Case Rep) Vol. 2017 (Jul 19 2017) ISSN: 1757-790X [Electronic] England
• PMID: 28724595 (Publication Type: Case Reports, Journal Article)
• Copyright: © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Chemical References

• Antihypertensive Agents

Topics

• Antihypertensive Agents (therapeutic use)
• Blood Pressure
• Cerebellum (pathology)
• Cerebral Infarction (diagnosis, etiology)
• Cerebrum (pathology)
• Diagnosis, Differential
• Edema
• Humans
• Hypertension (complications)
• Hypertensive Encephalopathy (diagnosis, drug therapy, pathology)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Pons (pathology)
• Tomography, X-Ray Computed
• Vasculitis, Central Nervous System (diagnosis, pathology)
• White Matter (pathology)