Two cases of malignant hypertension with reversible diffuse leukoencephalopathy exhibiting a reversible nocturnal blood pressure "riser" pattern.
We report two cases of malignant hypertension with reversible diffuse leukoencephalopathy demonstrating a nocturnal blood pressure (BP) rising pattern ("riser" pattern). Case 1 was a 54-year-old man diagnosed with malignant hypertension who presented with diffuse leukoencephalopathy and nocturnal BP rise during the acute phase. These abnormal findings diminished after treatment of hypertension. Case 2 was a 50-year-old woman diagnosed with malignant hypertension in association with leukoencephalopathy, heart failure and acute renal failure. She also presented with a "riser" pattern during the acute phase. In contrast to case 1, the leukoencephalopathy and "riser" pattern in case 2 were not improved even after 1 month of treatment. Following intensive antihypertensive treatment, renal failure was improved in case 1, but renal failure was not improved after 1 month in case 2. In conclusion, a possible explanation of this phenomenon is that a causative volume overload due to renal dysfunction produced the temporal leukoencephalopathy-like brain edema and "riser" pattern in these cases.
Eguchi
Kazuo
K
Department of Internal Medicine, Nishiarita Kyoritsu Hospital, Saga, Japan. kazuo-eg@po.saganet.ne.jp
Kasahara
Kentaro
K
Nagashima
Akinori
A
Mor
Tadashi
T
Nii
Takanobu
T
Ibaraki
Kazuo
K
Kario
Kazuomi
K
Shimada
Kazuyuki
K
D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm / Q000502:physiology*; D005260:Female; D006801:Humans; D006974:Hypertension, Malignant / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D020343:Hypertensive Encephalopathy / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged