title: A Case of Hypertensive Encephalopathy with Enlarged Optic Nerve Sheath Measured by Transorbital Sonography.
abstract: This case report describes our experience in using transorbital sonography to evaluate pathological changes in the central nervous system in hypertensive encephalopathy. A 49-year-old man with nausea, headache, and mild confusion was diagnosed with hypertensive encephalopathy by brain magnetic resonance imaging (MRI), which revealed vasogenic edema in the bilateral thalamus and the brain stem. Lumbar puncture showed no severe intracranial hypertension. Transorbital sonography showed an increase in the optic nerve sheath diameter (ONSD). Repeated examination revealed a return of the ONSD to an almost normal range after a reduction in blood pressure and a resolution of symptoms. An improvement in cerebral vasogenic edema was confirmed by brain MRI. ONSD might be related to the severity of cerebral vasogenic edema. Repeated measurement of ONSD by transorbital sonography may be useful to assess the pathological course and the effect of treatment in hypertensive encephalopathy.
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan. Electronic address: takayakitano@med.kawasaki-m.ac.jp.
authors.forename: Takaya
authors.initials: T
authors.lastname: Kitano
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan.
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Nezu
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Mukai
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan.
authors.forename: Jyunichi
authors.initials: J
authors.lastname: Uemura
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Wada
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Yagita
mesh_terms: D006801:Humans; D020343:Hypertensive Encephalopathy / Q000150:complications*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009186:Myelin Sheath / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000150:complications* / Q000000981:diagnostic imaging*; D014463:Ultrasonography
keywords: Optic nerve sheath; hypertensive encephalopathy; posterior reversible encephalopathy syndrome; transorbital sonography