Diffuse brainstem hypertensive encephalopathy in a patient with renal failure: A case report

Predominant diffuse brainstem hypertensive encephalopathy is rare, especially in a patient with renal failure. Despite the severity of the neuroradiological findings, the clinical manifestations are mild. The radiological abnormalities resolved after blood pressure controlled. We report a patient with transient diffuse brainstem lesions on MRI. He had hypertension and renal failure. His neurological symptoms were disproportionately mild compared with the MRI features, which were of diffuse hyperintensities in the brainstem on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images. There were no accompanying changes in the parieto-occipital lobe. We consider that extremely high blood pressure may provoke diffuse brainstem lesions. Renal failure may aggravate this damage.