Blurred vision with acute hypertension indicating hypertensive brainstem encephalopathy - Case report

Abstract

A 49-year-old woman presented with hypertensive brainstem encephalopathy (HBE) manifesting as visual disturbance and papilledema but no other neurological abnormal findings. Magnetic resonance (MR) imaging showed extensive lesions in the brainstem and bilateral thalami but not in the occipital lobes. The patient also had renal failure and underwent hemodialysis. Her visual disturbance and MR lesions resolved rapidly after antihypertensive treatment. This case of HBE only caused visual disturbance despite the presence of massive brainstem edema. The presence of fetal-type posterior cerebral artery may have spared the occipital lobe. Clinicians should consider HBE in hypertensive patients with blurred vision. HBE is reversible if immediate antihypertensive treatment is initiated, but neurological sequelae may develop if treatment is delayed.