Reversible hypertensive brainstem encephalopathy coexistent with acute intracerebral hemorrhage

• Main Authors: Mehmet Akif Topçuoğlu, Esma Binol, Ethem Murat Arsava, Kader Karlı Oğuz, Ali Ünal, Sevda Diker, Lale Mehdikhanova, Erhan Akpınar, Rahşan Göçmen
• Format: Article
• Language: English
• Published: Turkish Society of Cerebrovascular Diseases 2019-04-01
• Series: Türk Beyin Damar Hastalıkları Dergisi
• Subjects: Posterior leukoencephalopathy syndrome; central pontine myelinolizis; stroke; pons
• Online Access: https://www.journalagent.com/tbdhd/pdfs/TBDHD-36449-CASE_REPORT-TOPCUOGLU.pdf

We report two cases of reversible hypertensive brainstem encephalopathy (RHBE) syndrome with other concurrent manifestations of malignant hypertension. RHBE was accompanied by hypertensive putaminal hemorrhage in one case, and by intra-ventricular hemorrhage resulting acute obstructive hydrocephalus along with multiple small acute infarctions in the other. Diffusion-weighted imaging and corresponding apparent diffusion coefficient mapping disclosed increased diffusion suggestive of vasogenic edema centered in the pons. No lesion indicative for posterior reversible encephalopathy syndrome (PRES) was noted in the supratentorial regions. These cases indicate that mechanisms involved in development of RHBE and hypertensive PRES may have some differences, albeit both share main lines. These cases also underline that awareness and knowledge about relatively specific clinic-radiological syndrome caused by RHBE seem to be critical. Acute treatment and early prognostification are just only accurate with such a familiarity.