Hypertensive encephalopathy. Magnetic resonance imaging demonstration of reversible cortical and white matter lesions

R. A. Hauser, D. M. Lacey and M. R. Knight
Department of Neurology, Medical College of Hampton Roads, Norfolk, VA 23507.

Computed tomographic (CT) and magnetic resonance imaging (MRI) views of the brain were obtained in two adults and one child with hypertensive encephalopathy (HTE). Noncontrast CT was normal in one case and demonstrated decreased density posteriorly in two cases; MRI demonstrated focal, symmetric increased signal intensity in white matter and cortex, with occipital lobe involvement in each case. These lesions were better visualized on T2-weighted than on spin density images and were resolved on follow-up MRI four to five weeks later. These MRI studies support the concept that HTE is caused by the multifocal extravasation of fluid and proteins across the blood-brain barrier during "breakthrough" of cerebral autoregulation. We found that MRI appears more sensitive than CT and better defines the anatomy of cerebral involvement in HTE.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Posterior Reversible Encephalopathy Syndrome, Part 1: Fundamental Imaging and Clinical Features
Bartynski
Am. J. Neuroradiol. 2008;29:1036-1042.
ABSTRACT | FULL TEXT  

A severe neurological sequela in acute intermittent porphryria: presentation of a case from encephalopathy to quadriparesis
GURSES et al.
Br. J. Radiol. 2008;81:e135-e140.
ABSTRACT | FULL TEXT  

Clinical Spectrum of Reversible Posterior Leukoencephalopathy Syndrome
Lee et al.
Arch Neurol 2008;65:205-210.
ABSTRACT | FULL TEXT  

Reversible Posterior Leukoencephalopathy and Adie's Pupil After Measles Vaccination
Aydon et al.
J Child Neurol 2006;21:525-527.
ABSTRACT  

Brain Stem Hypertensive Encephalopathy Evaluated by Line Scan Diffusion-Weighted Imaging
Nagata et al.
Am. J. Neuroradiol. 2004;25:803-806.
ABSTRACT | FULL TEXT  

Diffuse Metabolic Abnormalities in Reversible Posterior Leukoencephalopathy Syndrome
Eichler et al.
Am. J. Neuroradiol. 2002;23:833-837.
ABSTRACT | FULL TEXT  

Reversible Posterior Leukoencephalopathy Syndrome: Evaluation with Diffusion-Tensor MR Imaging
Mukherjee and McKinstry
Radiology 2001;219:756-765.
ABSTRACT | FULL TEXT  

Transient lesion in the splenium of the corpus callosum: three further cases in epileptic patients and a pathophysiological hypothesis
Polster et al.
J. Neurol. Neurosurg. Psychiatry 2001;70:459-463.
ABSTRACT | FULL TEXT  

CT and MR Imaging of Nontraumatic Neurologic Emergencies
Provenzale
Am. J. Roentgenol. 2000;174:289-299.
FULL TEXT  

Quantitative MR Diffusion Mapping and Cyclosporine-Induced Neurotoxicity
Coley et al.
Am. J. Neuroradiol. 1999;20:1507-1510.
ABSTRACT | FULL TEXT  

Topical Review: Hypertensive Encephalopathy, Reversible Occipitoparietal Encephalopathy, or Reversible Posterior Leukoencephalopathy: Three Names for an Old Syndrome
Pavlakis et al.
J Child Neurol 1999;14:277-281.
ABSTRACT  

High-Altitude Cerebral Edema Evaluated With Magnetic Resonance Imaging: Clinical Correlation and Pathophysiology
Hackett et al.
JAMA 1998;280:1920-1925.
ABSTRACT | FULL TEXT  

Diffusion-Weighted Imaging Discriminates Between Cytotoxic and Vasogenic Edema in a Patient With Eclampsia
Schaefer et al.
Stroke 1997;28:1082-1085.
ABSTRACT | FULL TEXT  

A Reversible Posterior Leukoencephalopathy Syndrome
Schwartz et al.
NEJM 1996;334:1743-1746.
FULL TEXT  

A Reversible Posterior Leukoencephalopathy Syndrome
Hinchey et al.
NEJM 1996;334:494-500.
ABSTRACT | FULL TEXT  

Hypertensive Encephalopathy After Bilateral Carotid Endarterectomy
Ille et al.
Stroke 1995;26:488-491.
ABSTRACT | FULL TEXT