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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">August 2000,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">21 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1366; </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-2272--62138016311" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Gregory Youngnam Chang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Department of NeurologyUniversity of Southern CaliforniaLos Angeles, CA</div>M.D</span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Gregory%2BYoungnam%2BChang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Chang%20GY&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AGregory%2BYoungnam%2BChang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">James R. Keane </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of NeurologyUniversity of Southern CaliforniaLos Angeles, CA</div>M.D</span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=James%2BR.%2BKeane%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Keane%20JR&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJames%2BR.%2BKeane%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view "><span class="highwire-journal-article-marker-start"></span><div class="section" id="sec-1"><p id="p-1">We enjoyed reading the article by de Seze et al <a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">(1)</a>, in which they presented two cases of hypertensive encephalopathy with predominant brain stem involvement and discussed the differential diagnosis from brain stem tumors.</p><p id="p-2">We have been interested in this subject and have published three similar cases <a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">(2)</a>. In all of our cases, the initial neuroradiologic interpretation was “massive brain stem infarction.” Nonspecific symptoms, such as a mild headache and gait unsteadiness of several days, characterize hypertensive brain stem encephalopathy in contrast to infarction or tumor. We recently encountered a fourth case that again illustrates this entity.</p><p id="p-3">A 55-year-old man had 1 week of mild headache and walking difficulty. His blood pressure (BP) was 250/145 mm Hg and his neurologic examination was normal. His CT scan was read as most consistent with an acute brain stem infarction. (<a id="xref-fig-1-1" class="xref-fig" href="#F1">Fig 1</a> [left]). Two weeks later, he felt well. His BP was 130/75 mm Hg and his MR results (<a id="xref-fig-1-2" class="xref-fig" href="#F1">Fig 1</a> [right]) showed resolution of brain stem swelling, without any signal changes in the brain stem.</p><div id="F1" class="fig pos-float  odd"><div class="highwire-figure"><div class="fig-inline-img-wrapper"><div class="fig-inline-img"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/21/7/1366/F1.large.jpg?width=800&amp;height=600&amp;carousel=1" title="Left, Axial CT cuts show hypodense, swollen pons. Obliteration of upper fourth ventricle has resulted in enlarged temporal horns.   Right, Fluid-attenuated inversion recovery sequence at follow-up is normal. Imaging parameters 9000/128/2200 (TR/TE/TI). T2-weighted and diffusion-weighted images normal (not shown)." class="highwire-fragment fragment-images colorbox-load" rel="gallery-fragment-images-891292280" data-figure-caption="&lt;div class=&quot;highwire-markup&quot;&gt;&lt;div xmlns=&quot;http://www.w3.org/1999/xhtml&quot;&gt;&lt;em&gt;Left,&lt;/em&gt; Axial CT cuts show hypodense, swollen pons. Obliteration of upper fourth ventricle has resulted in enlarged temporal horns.   &lt;em&gt;Right,&lt;/em&gt; Fluid-attenuated inversion recovery sequence at follow-up is normal. Imaging parameters 9000/128/2200 (TR/TE/TI). T2-weighted and diffusion-weighted images normal (not shown).&lt;/div&gt;&lt;/div&gt;" data-icon-position="" data-hide-link-title="0"><span class="hw-responsive-img"><img class="highwire-fragment fragment-image lazyload" alt="fig 1." src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" data-src="http://ajnr-stage2.stage.highwire.org/content/ajnr/21/7/1366/F1.medium.gif" width="650" height="465"/><noscript><img class="highwire-fragment fragment-image" alt="fig 1." src="http://ajnr-stage2.stage.highwire.org/content/ajnr/21/7/1366/F1.medium.gif" width="650" height="465"/></noscript></span></a></div></div><ul class="highwire-figure-links inline"><li class="download-fig first"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/21/7/1366/F1.large.jpg?download=true" class="highwire-figure-link highwire-figure-link-download" title="Download fig 1." data-icon-position="" data-hide-link-title="0">Download figure</a></li><li class="new-tab"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/21/7/1366/F1.large.jpg" class="highwire-figure-link highwire-figure-link-newtab" target="_blank" data-icon-position="" data-hide-link-title="0">Open in new tab</a></li><li class="download-ppt last"><a href="/highwire/powerpoint/15822" class="highwire-figure-link highwire-figure-link-ppt" data-icon-position="" data-hide-link-title="0">Download powerpoint</a></li></ul></div><div class="fig-caption" xmlns:xhtml="http://www.w3.org/1999/xhtml"><span class="fig-label"><span class="sc">fig</span> 1.</span> <p id="p-5" class="first-child"><em>Left,</em> Axial CT cuts show hypodense, swollen pons. Obliteration of upper fourth ventricle has resulted in enlarged temporal horns.  </p><p id="p-6"><em>Right,</em> Fluid-attenuated inversion recovery sequence at follow-up is normal. Imaging parameters 9000/128/2200 (TR/TE/TI). T2-weighted and diffusion-weighted images normal (not shown).</p><div class="sb-div caption-clear"></div></div></div><p id="p-4">Mild symptoms, a very high BP, and a normal neurologic examination conflict with scans in patients that dramatically confirm hypertensive brain stem encephalopathy. Marked clinicoradiologic dissociation rules out major brain stem infarction, and makes tumor unlikely.</p></div><div class="section ref-list" id="ref-list-1"><h2 class="">References</h2><ol class="cit-list"><li><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1 in text" id="ref-1">↵</a><div class="cit ref-cit ref-other" id="cit-21.7.1366.1"><div class="cit-metadata"><cite>de Seze J,   Mastain B,  Stojkovic T,   et al.  <strong>Unusual MR Findings in the Brain Stem in Arterial Hypertension.</strong> <span class="cit-source">AJNR Am J Neuroradiol</span> <span class="cit-pub-date">2000</span>;<span class="cit-vol">21</span>:<span class="cit-fpage">391</span>-394</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo4OiIyMS8yLzM5MSI7czo0OiJhdG9tIjtzOjIwOiIvYWpuci8yMS83LzEzNjYuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2 in text" id="ref-2">↵</a><div class="cit ref-cit ref-other" id="cit-21.7.1366.2"><div class="cit-metadata"><cite>Chang GY,   Keane JR.    <strong>Hypertensive brainstem encephalopathy: Three cases presenting with severe brainstem edema.</strong> <span class="cit-source">Neurology</span> <span class="cit-pub-date">1999</span>;<span class="cit-vol">53</span>:<span class="cit-fpage">652</span>-654</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6OToibmV1cm9sb2d5IjtzOjU6InJlc2lkIjtzOjg6IjUzLzMvNjUyIjtzOjQ6ImF0b20iO3M6MjA6Ii9ham5yLzIxLzcvMTM2Ni5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li></ol></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">Copyright © American Society of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 21</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 7 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Aug 2000 </div></div>
      
      
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