Blurred vision with acute hypertension indicating hypertensive brainstem encephalopathy-case report-.
A 49-year-old woman presented with hypertensive brainstem encephalopathy (HBE) manifesting as visual disturbance and papilledema but no other neurological abnormal findings. Magnetic resonance (MR) imaging showed extensive lesions in the brainstem and bilateral thalami but not in the occipital lobes. The patient also had renal failure and underwent hemodialysis. Her visual disturbance and MR lesions resolved rapidly after antihypertensive treatment. This case of HBE only caused visual disturbance despite the presence of massive brainstem edema. The presence of fetal-type posterior cerebral artery may have spared the occipital lobe. Clinicians should consider HBE in hypertensive patients with blurred vision. HBE is reversible if immediate antihypertensive treatment is initiated, but neurological sequelae may develop if treatment is delayed.
Ogaki
Kotaro
K
Department of Neurology, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.
Fukae
Jiro
J
Noda
Kazuyuki
K
Fujishima
Kenji
K
Hattori
Nobutaka
N
Okuma
Yasuyuki
Y
D000208:Acute Disease / Q000628:therapy; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001929:Brain Edema / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D001933:Brain Stem / Q000098:blood supply / Q000473:pathology* / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology; D002941:Circle of Willis / Q000002:abnormalities / Q000502:physiology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology; D020343:Hypertensive Encephalopathy / Q000473:pathology* / Q000503:physiopathology; D002546:Ischemic Attack, Transient / Q000209:etiology* / Q000473:pathology* / Q000503:physiopathology; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000473:pathology / Q000502:physiology; D009778:Occipital Lobe / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D020769:Posterior Cerebral Artery / Q000002:abnormalities / Q000502:physiology; D013788:Thalamus / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D016896:Treatment Outcome; D015354:Vision, Low / Q000209:etiology*
D000959:Antihypertensive Agents