Hypertensive encephalopathy with unusual MRI findings

We report a cace of hypertensive encephalopathy (HTE) with unusual MRI findings. A 28-year-old woman was admitted to our hospital because of right putaminal hemorrhage with intraventricular rupture. Her arterial blood pressure was 206/140 mmHg. She was drowsy with severe headache and had left visual disturbance, horizontal gaze nystagmus, and mild left hemiparesis. T2-weighted MRI revealed diffuse hyperintense lesions in the brainstem, cerebellum, and periventricular white matter. MRI also demonstrated swelling of the brainstem. Following the initiation of anti-hypertensive therapy, her clinical symptoms resolved rapidly. Follow-up MRI showed marked improvement of the above findings, with resolution of edema. Although occipital hyperintensity is thought to be a typical T2-weighted MRI finding in HTE patients, our case displayed additional multiple lesions in other areas than the occipital lobe. It appears therefore that we should recognize possible variations in the pattern of MRI findings in patients with HTE.