title: Malignant hypertension with reversible brainstem hypertensive encephalopathy and thrombotic microangiopathy.
abstract: A 42-year-old woman presented with headache and nausea. Severe hypertension, renal dysfunction, thrombocytopenia, and anemia were present. A magnetic resonance imaging (MRI) scan of her head revealed widespread hyperintense lesions located in the brainstem and cerebellum on T2-weighted and fluid-attenuated inversion recovery imaging. Hypertensive encephalopathy was suspected, and antihypertensive therapy was started. A second MRI of the patient's head on day 12 of hospitalization revealed that the hyperintensities in the brainstem and cerebellum had almost disappeared, and that thrombocytopenia, anemia, and renal dysfunction had also gradually improved. Test results led to a diagnosis of malignant hypertension. This patient was regarded as suffering from malignant hypertension with reversible brainstem hypertensive encephalopathy (RBHE) and thrombotic microangiopathy (TMA). RBHE and TMA are known to occur as complications of malignant hypertension, but there has been no previous report of them occurring simultaneously. RBHE and TMA related to malignant hypertension are both conditions that can be improved by the rapid institution of antihypertensive therapy, and as such, early diagnosis and treatment are important. When treating patients with malignant hypertension, the possibility that it may be complicated by both RBHE and TMA must be kept in mind.
authors.affiliation: Department of Neurology and Cerebrovascular Medicine, Saitama International Medical Center, Saitama Medical University, Saitama, Japan. ideguchi@saitama-med.ac.jp
authors.forename: Ichiro
authors.initials: I
authors.lastname: Deguchi
authors.forename: Akira
authors.initials: A
authors.lastname: Uchino
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Suzuki
authors.forename: Norio
authors.initials: N
authors.lastname: Tanahashi
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001933:Brain Stem / Q000473:pathology; D002531:Cerebellum / Q000473:pathology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D006974:Hypertension, Malignant / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D020343:Hypertensive Encephalopathy / Q000175:diagnosis / Q000209:etiology*; D018810:Magnetic Resonance Angiography; D057049:Thrombotic Microangiopathies / Q000175:diagnosis / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents