Acute hypertensive encephalopathy with widespread small-vessel disease at MRI in a diabetic patient: pathogenetic hypotheses.
We report unusual magnetic resonance imaging (MRI) findings in a diabetic patient with neglected hypertension and hyperglycemia, presenting with seizures and coma. Outcome was fatal despite intensive care. The MRI findings included bilateral insular and temporo-occipital grey and white matter involvement, and numerous, scattered, lacunar-like lesions involving the peripheral and deep white matter, basal ganglia grey matter, and brainstem. Lesions had a low apparent diffusion coefficient, and some enhanced following contrast injection. Hypertensive encephalopathy with widespread and severe acute small-vessel disease was considered. Pathophysiology is discussed.
Cotton
F
F
Department of Radiology, Centre Hospitalier Lyon Sud, 69495 Pierre Bénite Cedex, France.
Kamoun
S
S
Rety-Jacob
F
F
Tran-Minh
V A
VA
Nighoghossian
N
N
Hermier
M
M
D000208:Acute Disease; D048909:Diabetes Complications / Q000473:pathology*; D005260:Female; D006801:Humans; D020343:Hypertensive Encephalopathy / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008833:Microcirculation; D008875:Middle Aged