Reversible brainstem hypertensive encephalopathy (RBHE): Clinicoradiologic dissociation.

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  • Author(s): Shintani S;Shintani S; Hino T; Ishihara S; Mizutani S; Shiigai T
  • Source:
    Clinical neurology and neurosurgery [Clin Neurol Neurosurg] 2008 Dec; Vol. 110 (10), pp. 1047-53. Date of Electronic Publication: 2008 Aug 03.
  • Publication Type:
    Case Reports; Journal Article
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: Netherlands NLM ID: 7502039 Publication Model: Print-Electronic Cited Medium: Print ISSN: 0303-8467 (Print) Linking ISSN: 03038467 NLM ISO Abbreviation: Clin Neurol Neurosurg Subsets: MEDLINE
    • Publication Information:
      Publication: Amsterdam : Elsevier
      Original Publication: Assen, Van Gorcum.
    • Subject Terms:
      Brain Stem/*pathology ; Hypertension/*pathology ; Hypertensive Encephalopathy/*pathology; Aged, 80 and over ; Brain Edema/etiology ; Brain Edema/pathology ; Brain Edema/physiopathology ; Brain Stem/physiopathology ; Humans ; Hypertension/complications ; Hypertension/physiopathology ; Hypertensive Encephalopathy/complications ; Hypertensive Encephalopathy/physiopathology ; Magnetic Resonance Spectroscopy/methods ; Male ; Middle Aged
    • Abstract:
      We report two cases of reversible brainstem hypertensive encephalopathy (RBHE) with unusual magnetic resonance (MR) findings. Patient 1, an 85-year-old man without a history of hypertension, developed acute severe hypertension and mild consciousness disturbance as the only symptoms. Patient 2, a 46-year-old man with an untreated hypertension, presented with extremely high blood pressure and general fatigue, vertigo, and mild dysarthria as the initial manifestations. In these patients, fluid-attenuated inversion recovery (FLAIR) and T2-weighted MR images revealed diffuse hyperintensities in the brainstem. Diffusion-weighted imaging (DWI) findings were normal, and apparent diffusion coefficient (ADC) values were increased in the brainstem. The supratentorial regions were largely spared, and mildly diffuse hyperintensities were noted in the white matter. There were no accompanying changes in the occipital lobe and cerebellum. The lesions completely resolved after stabilization of blood pressure. The normal DWI findings and high ADC values were consistent with vasogenic edema due to severe hypertension. The characteristics of RBHE are a very high blood pressure, mild clinical and neurologic symptoms, rapidly improved MR findings after initial treatment with the control of hypertension, and a marked clinicoradiologic dissociation.
    • Publication Date:
      Date Created: 20080805 Date Completed: 20090112 Latest Revision: 20220311
    • Publication Date:
      20250114
    • Accession Number:
      10.1016/j.clineuro.2008.06.012
    • Accession Number:
      18676082