Retinopathy and Choroidopathy as the Initial Signs of Hypertensive Brainstem Encephalopathy

CT diagnosis of hypertensive brainstem encephalopathy (HBE): A diagnostic challenge in the emergency department

“…Laboratory tests during his hospitalization were negative, including inflammatory and collagen-vascular-disease markers. These findings, along with the rapid clinical evolution and resolution of both symptoms and brainstem lesions with correction of hypertension, established the clinical diagnosis of hypertensive encephalopathy ( 12 ).…”

“…Isolated involvement of the brainstem and cerebellum is rare, with a few cases in the literature. Although MRI has greatly increased the recognition of hypertensive encephalopathy, the brainstem variant has been rarely reported ( 1 , 2 , 3 , 9 , 10 , 11 , 12 , 13 ). This occurs more often in patients less than 40 years of age and is associated with secondary hypertension ( 4 ).…”

“…MRI characteristically shows a posterior leukoencephalopathy, affecting predominantly the white matter of the parieto-occipital regions ( 20 ). On the other hand, HBE affects predominantly the brainstem and cerebellum, while parieto-occipital regions are spared ( 12 ). However, brainstem and deep-white-matter involvement seems to have less reversibility than cortical and subcortical areas ( 19 ).…”

CT diagnosis of hypertensive brainstem encephalopathy (HBE): A diagnostic challenge in the emergency department

“…Laboratory tests during his hospitalization were negative, including inflammatory and collagen-vascular-disease markers. These findings, along with the rapid clinical evolution and resolution of both symptoms and brainstem lesions with correction of hypertension, established the clinical diagnosis of hypertensive encephalopathy ( 12 ).…”

“…Isolated involvement of the brainstem and cerebellum is rare, with a few cases in the literature. Although MRI has greatly increased the recognition of hypertensive encephalopathy, the brainstem variant has been rarely reported ( 1 , 2 , 3 , 9 , 10 , 11 , 12 , 13 ). This occurs more often in patients less than 40 years of age and is associated with secondary hypertension ( 4 ).…”

“…MRI characteristically shows a posterior leukoencephalopathy, affecting predominantly the white matter of the parieto-occipital regions ( 20 ). On the other hand, HBE affects predominantly the brainstem and cerebellum, while parieto-occipital regions are spared ( 12 ). However, brainstem and deep-white-matter involvement seems to have less reversibility than cortical and subcortical areas ( 19 ).…”

Posterior reversible encephalopathy syndrome

“…The cause of visual loss may be multifactorial in these patients, and a high degree of suspicion for concomitant cortical disease is necessary. The radiographic variant of PRES that mainly affects the brainstem may be associated with hypertensive retinal changes [43,33]. Retinal detachment can coexist with PRES [44], and in these cases, the degree of visual loss due to edema may only be recognized over time.…”

CT diagnosis of hypertensive brainstem encephalopathy (HBE): A diagnostic challenge in the emergency department

“…Laboratory tests during his hospitalization were negative, including inflammatory and collagen-vascular-disease markers. These findings, along with the rapid clinical evolution and resolution of both symptoms and brainstem lesions with correction of hypertension, established the clinical diagnosis of hypertensive encephalopathy ( 12 ).…”

“…Isolated involvement of the brainstem and cerebellum is rare, with a few cases in the literature. Although MRI has greatly increased the recognition of hypertensive encephalopathy, the brainstem variant has been rarely reported ( 1 , 2 , 3 , 9 , 10 , 11 , 12 , 13 ). This occurs more often in patients less than 40 years of age and is associated with secondary hypertension ( 4 ).…”

“…MRI characteristically shows a posterior leukoencephalopathy, affecting predominantly the white matter of the parieto-occipital regions ( 20 ). On the other hand, HBE affects predominantly the brainstem and cerebellum, while parieto-occipital regions are spared ( 12 ). However, brainstem and deep-white-matter involvement seems to have less reversibility than cortical and subcortical areas ( 19 ).…”

Posterior reversible encephalopathy syndrome

“…The cause of visual loss may be multifactorial in these patients, and a high degree of suspicion for concomitant cortical disease is necessary. The radiographic variant of PRES that mainly affects the brainstem may be associated with hypertensive retinal changes [43,33]. Retinal detachment can coexist with PRES [44], and in these cases, the degree of visual loss due to edema may only be recognized over time.…”

CT diagnosis of hypertensive brainstem encephalopathy (HBE): A diagnostic challenge in the emergency department

“…Laboratory tests during his hospitalization were negative, including inflammatory and collagen-vascular-disease markers. These findings, along with the rapid clinical evolution and resolution of both symptoms and brainstem lesions with correction of hypertension, established the clinical diagnosis of hypertensive encephalopathy ( 12 ).…”

“…Isolated involvement of the brainstem and cerebellum is rare, with a few cases in the literature. Although MRI has greatly increased the recognition of hypertensive encephalopathy, the brainstem variant has been rarely reported ( 1 , 2 , 3 , 9 , 10 , 11 , 12 , 13 ). This occurs more often in patients less than 40 years of age and is associated with secondary hypertension ( 4 ).…”

“…MRI characteristically shows a posterior leukoencephalopathy, affecting predominantly the white matter of the parieto-occipital regions ( 20 ). On the other hand, HBE affects predominantly the brainstem and cerebellum, while parieto-occipital regions are spared ( 12 ). However, brainstem and deep-white-matter involvement seems to have less reversibility than cortical and subcortical areas ( 19 ).…”

Posterior reversible encephalopathy syndrome

“…The cause of visual loss may be multifactorial in these patients, and a high degree of suspicion for concomitant cortical disease is necessary. The radiographic variant of PRES that mainly affects the brainstem may be associated with hypertensive retinal changes [43,33]. Retinal detachment can coexist with PRES [44], and in these cases, the degree of visual loss due to edema may only be recognized over time.…”