Probable Isolated Hypertensive Brainstem Encephalopathy Combined with Intracerebral Hemorrhage: a Case Report

Hypertensive encephalopathy is an acute neurological syndrome caused by a sudden increase of systemic blood pressure (1, 2). The imaging abnormalities are predominant in the parieto-occipital subcortical white matter. The clinical and radiological abnormalities are reversible after antihypertensive treatment (3). Therefore, hypertensive encephalopathy has been called posterior reversible encephalopathy syndrome (PRES). Brainstem was involved in 58% of hypertensive encephalopathy in one study (4) but isolated brainstem involvement of hypertensive encephalopathy has been rarely reported (5-9). In this case, rare isolated hypertensive brainstem encephalopathy was occurred with intracerebral hemorrhage (ICH). ICH is more common acute neurologic complication of systemic hypertension and may be an indicator of hypertensive attack in hypertensive encephalopathy. On the other hand, acute elevations of intracranial pressure (ICP) due to ICH can cause a further increase of systemic hypertension and an increased intracerebral capillary pressure and permeability (10, 11).