Hypertensive Encephalopathy Progressing with the Atypical Findings of Computed Tomography and Magnetic Resonance Imaging

Öz

Hypertensive encephalopathy is an acute organic cerebral syndrome which occurs when the elevation in the blood pressure exceeds the limit of cerebral vascular auto regulation. Alterations resulting from vasogenic edema affecting cortical and sub cortical white matter areas, especially in the parietal-occipital lobes are observed in the radiological imaging. Involvement of brainstem, basal ganglia and cerebellum is infrequent, if involved it occurs usually in association with the parietal-occipital white matter changes. In this study, clinical, laboratory, computed tomography and magnetic resonance imaging findings of a case with atypical hypertensive encephalopathy involving predominantly the frontal-temporal areas in the radiological evaluations were presented and the differential diagnosis was discussed in the light of literature. ©2007, Firat University, Medical Faculty

Anahtar Kelimeler

• -

Atipik Bilgisayarlı Tomografi ve Manyetik Rezonans Görüntüleme Bulgularıyla Seyreden Hipertansif Ensefalopati

Öz

Hipertansif ensefalopati kan basıncındaki artışın serebral vasküler otoregülasyon sınırının üzerine çıkması durumunda ortaya çıkan akut organik beyin sendromudur. Radyolojik görüntülemelerde özellikle paryetooksipital bölgelerde kortikal ve subkortikal beyaz cevher alanlarını etkileyen vazojenik ödeme bağlı değişiklikler görülür. Hipertansif ensefalopatide ödeme bağlı değişiklikler sık olmamakla birlikte beyin sapı, bazal ganglion ve serebellum gibi beynin diğer alanlarında görülse de bu değişiklikler genellikle paryetooksipital bölgelerin tutulumu ile birlikte olmaktadır. Burada, radyolojik incelemelerde ağırlıklı olarak frontotemporal alanları etkileyen atipik hipertansif ensefalopatili bir olgunun klinik, laboratuar, bilgisayarlı tomografi ve manyetik rezonans görüntüleme bulguları sunulmuş ve ayırıcı tanı literatür eşliğinde tartışılmıştır. ©2007, Fırat Üniversitesi, Tıp Fakültesi

Anahtar Kelimeler

• Hipertansif ensefalopati, Bilgisayarlı tomografi, Manyetik rezonans görüntüleme

Kaynakça

1. Vaughan CJ, Delanty N. Hypertensive emergencies. Lancet 2000; 356:411-417.
2. Schwartz RB, Jones KM, Kalina P, et al. Hypertensive encephalopathy: findings on CT, MR imaging, and SPECT imaging in 14 cases. AJR 1992; 159:379-383.
3. Hinchey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996; 334:494-500.
4. Casey SO, Sampaio RC, Michel E, Truwit CL. Posterior reversible leukoencephalopathy syndrome: utility of fluidattenuated inversion recovery MR imaging in the detection of cortical and subcortical lesions. Am J Neuroradiol 2000; 21:1199-1206.
5. Phillips SJ, Whisnant JP. Hypertension and the brain. The National High Blood Pressure Education Program. Arch Intern Med. 1992; 152:938-945.
6. Dedeoglu IO, Springate JE, Najdzionek JS, Feld LG. Hypertensive encephalopathy and reversible magnetic resonance imaging changes in a renal transplant patient. Pediatr Nephrol 1996; 10:769-771.
7. Rail DL, Perkin GD. Computerized tomographic appearance of hypertensive encephalopathy. Arch Neurol 1980; 37:310-311.
8. Beausang-Linder M, Bill A. Cerebral circulation in acute arterial hypertension: protective effects of sympathetic nervous activity. Acta physiol Scand 1981; 111:193-199.

9. Edvinsson L, Owman C, Sjoberg N-O. Autonomic nerves, mast cells, and amine receptors in human brain vessels: histochemical and pharmacologic study. Brain Res 1976; 115:377-393.
10. Thambisetty M, Biousse V, Newman NJ. Hypertensive brainstem encephalopathy: clinical and radiographic features. J Neurol Sci 2003; 208:93-99.
11. Kumai Y, Toyoda K, Fuji K, Ibayashi S. Hypertensive encephalopathy extending into the whole brainstem and deep structures. Hypertens Res 2002; 25:797-800.
12. Koelfen W, Freund M, Gückel F, Rohr H, Schultze C. MRI of encephalitis in children: comparison of CT and MRI in the acute stage with long-term follow-up. Neuroradiology 1996; 38:73-79.