Hypertensive encephalopathy: findings on CT, MR imaging, and SPECT imaging in 14 cases.

Blurred Vision With Acute Hypertension Indicating Hypertensive Brainstem Encephalopathy -Case Report-

“…T 2 -weighted magnetic resonance (MR) imaging usually reveals hyperintense lesions most commonly involving the cortex or subcortical white matter of the occipital lobes and posterior parietal lobes. [29][30][31]36) Reversible posterior leukoencephalopathy syndrome (RPLS) or posterior reversible encephalopathy syndrome (PRES) is a similar clinical entity, but is not always associated with hypertension. 3,16) Recently, HE with predominant brainstem involvement has been described as hypertensive brainstem encephalopathy (HBE), which is a neurological emergency, so neurosurgeons, neuroradiologists, and neurologists should be aware of this disorder.…”

“…29) The proposed mechanism for HE mostly involves vasogenic edema caused by the breakdown of autoregulation. 30,31,36) The vertebrobasilar vessels are sparsely innervated by sympathetic nerves from the superior cervical ganglion, so the occipital lobes and infratentorial structures are susceptible to the breakdown of autoregulation caused by overperfusion induced by acute hypertension. Subacute fluid retention due to renal decompensation, which also occurred in our patient, is another important precipitating factor for cerebral hyperperfusion.…”

Encefalopatia hipertensiva associada a estado de mal epiléptico de repetição: relato de caso

“…Em virtude disso, sobrevem dilatação excessiva dos vasos cerebrais, causando o extravasamento de proteínas e de fluídos através da barreira hemato-encefálica, formando-se, assim, focos de edema cerebral 3,9 . Schwartz e colaboradores, em estudo realizado com TC, RMe SPECT (single-photon emission computed tomography), sustentam a teoria da quebra da auto-regulação como o mecanismo responsável pela fisiopatologia da encefalopatia hipertensiva 1 . Nesse estudo, o SPECT revelou uma hiperperfusão regional durante as crises hipertensivas, nas mesmas áreas com alterações em TC e RM.…”

“…Apresentamos o relato de um caso pediátrico que exemplifica uma situação clínica incomum, na qual se demonstrou que um quadro de repetidas crises convulsivas tinha por causa primária uma encefalopatia hipertensiva subjacente; uma síndrome neurológica que se instala em decorrência da elevação súbita e grave da pressão arterial, levando a alterações de neuroimagem, compatíveis com edema cerebral 1,2 . Essa síndrome caracteriza-se clinicamente por náuseas, vômitos, cefaléia, alteração no nível de consciência, distúrbios visuais, papiledema e convulsões 3 .…”

Reversible Posterior Leukoencephalopathy Syndrome

“…Although the underlying pathophysiology of PRLS has been controversial, disturbed permeability of cerebral vessels may be one candidate. The permeability of cerebral vessels may be disturbed in many pathologic conditions including angiitis, hypertensive encephalopathy (3, 7) that may develop low density lesions in cerebral CT, prolonged T2 lesions in cerebral MRI, and hyperperfusion (8,9) in single photon emission computed tomography (SPECT) images. Some patients with RPLS showed hypoperfusion in SPECT (10), but hyperperfusion can be also observed in these patients at least in their acute phases.…”