Subacute Hypertensive Reversible Leukoencephalopathy – a Case Report

Czech version

Authors: A. Haluzová ¹; R. Jura ¹; J. Bednařík ¹; S. Skutilová ¹; T. Andrašinová ¹; M. Keřkovský ²; A. Křivanová ³
Authors‘ workplace: Neurologická klinika LF MU a FN Brno ¹; Radiologická klinika LF MU a FN Brno ²; Interní kardiologická klinika LF MU a FN Brno ³
Published in: Cesk Slov Neurol N 2008; 71/104(6): 726-731
Category: Case Report

Overview

Hypertensive encephalopathy induced by essential or secondary arterial hypertension is characterised by a sudden onset of symptoms pointing to diffuse encephalopathy (headache, nausea, vomiting, vision problems, confusion or epileptic seizures) linked with an increase in blood pressure (BP, hypertensive crisis). In such case, the imaging methods applied, especially magnetic resonance (MR), show leukoencephalopathy. Both clinical symptoms and MR imaging findings are reversible after the blood pressure values have been normalised. We report a case of a 37-year old man who developed non-specific symptoms of encephalopathy over the period of one year (cephalea, vision disorders, behaviour changes, atactic walk). CT and MRI of the patient’s brain showed diffuse affection of the white matter of the brain, cerebellum and of the cerebral trunk. Inflammatory, demyelinisating, ischaemic, oncologic, metabolic and toxic aetiologies of leukoencephalopathy were excluded. In spite of absence of anamnestic data on arterial hypertension, and of normotensive values at admission, a hypertension crisis developed and clinical symptoms progressed into a picture of delirium. Blood pressure compensation resulted in the regression of clinical symptoms and a significant attenuation of cardiologic signs of encephalopathy, which was a confirmation of hypertensive etiology of leukoencephalopathy. Subsequently, the presence of chronic idiopathic arterial hypertension was confirmed, and secondary causes of hypertension including phaeochromocytoma were excluded. Hypertensive encephalopathy should be considered also in the case of protracted and fluctuating symptoms of encephalopathy and normal results for current blood pressure measurements.

Key words:
hypertensive encephalopathy – leukoencephalopathy

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