Case reportHypertension-Induced Cerebellar Encephalopathy and Hydrocephalus in a Male
Introduction
Hypertensive encephalopathy is a condition triggered by an abrupt elevation of systemic arterial blood pressure [1], [2], [3]. Its heralding features are failure of autoregulation, breakdown of the blood-brain barrier, and extravasation of fluid and protein into the brain parenchyma [4]. Hypertensive encephalopathy can be neurologically devastating, as it can lead to rapidly progressive headache, nausea, vomiting, seizure, and disturbed consciousness. The characteristic pattern of edema affects children and adults and most commonly involves the subcortical white matter of the occipital lobes [1], [2], [3], [4]. Immunosuppressive drugs, renovascular disease, eclampsia, and idiopathic essential hypertension can induce hypertensive encephalopathy [1], [2], [3].
This report describes an 11-year-old male with acutely elevated arterial blood pressure and subsequent encephalopathy. To our knowledge, acute obstructive hydrocephalus with cerebellar encephalopathy has not been reported in children. We emphasize that this condition might be misdiagnosed as tumor-associated hydrocephalus if it is not recognized early.
Section snippets
Case Report
An 11-year-old male presented to our outpatient clinic with a 6-month history of chronic headache characterized by dull bilateral temporal pain. One week before his presentation, the headaches had increased in severity. He had no vomiting or limb weakness.
Findings on physical and neurologic examination were normal. Transcranial color Doppler sonography revealed mild ventriculomegaly and possibly abnormal hyperechogenicity in the parenchyma of the posterior fossa. One week later, the patient
Discussion
Hypertensive encephalopathy, also known as reversible occipitoparietal encephalopathy or reversible posterior leukoencephalopathy, is induced by an abrupt elevation in arterial blood pressure and clinically characterized by headache, blurred vision, seizure, or disturbed consciousness [1]. In patients with hypertensive encephalopathy, abnormally high blood pressure and increased permeability of the vascular walls overpower their autoregulation of cerebral blood flow. Underlying etiologies of
References (15)
- et al.
A reversible posterior leukoencephalopathy syndrome
N Engl J Med
(1996) - et al.
Hypertensive encephalopathy, reversible occipitoparietal encephalopathy, or reversible posterior leukoencephalopathyThree names for an old syndrome
J Child Neurol
(1999) Posterior leukoencephalopathy syndrome
Postgrad Med J
(2001)- et al.
Primary hypertension-induced cerebellar encephalopathy causing obstructive hydrocephalus
J Neurosurg
(2003) - et al.
Hypertensive encephalopathyFindings on CT, MR imaging, and SPECT imaging in 14 cases
Am J Roentgenol
(1992) - et al.
Hypertensive encephalopathy in children
Am J Neuroradiol
(1997) - et al.
Acute hypertensive encephalopathyFindings on spin-echo and gradient echo MR imaging
Am J Roentgenol
(1994)
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Hypertensive Encephalopathy
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2015, European Journal of Paediatric NeurologyIsolated cerebellar involvement in posterior reversible encephalopathy syndrome
2015, Journal of the Neurological SciencesCitation Excerpt :He has been in satisfactory and stable condition for more than one year. Eight reports of nine patients met the inclusion criteria [6–13]. These included our two case studies, resulting in a total of 11 cases for this descriptive analysis.
Posterior reversible encephalopathy syndrome
2014, Handbook of Clinical NeurologyHypertensive encephalopathy presenting as status epilepticus in a three year old
2012, Journal of Emergency MedicineCitation Excerpt :The lesion was initially thought to be a glioma, and an EVD was placed to decrease the hydrocephalus. The patient’s symptoms resolved after placement of the shunt and it was determined that he had hypertensive encephalopathy secondary to a previously unidentified atrophic left kidney (10). An MRI done 6 weeks after his presentation documented resolution of the initial findings (10).
Hypertensive encephalopathy with obstructive hydrocephalus
2008, European Journal of Radiology ExtraCitation Excerpt :The changes are clearly demonstrated on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images [1–5]. Extensive brainstem and cerebellar edema induced by hypertensive encephalopathy can occasionally cause obstructive hydrocephalus [6–11]. We present a case of hypertensive encephalopathy accompanied by obstructive hydrocephalus and discuss the diagnostic usefulness of diffusion-weighted imaging (DWI).