Hirnstammödem bei hypertensiver Krise mit vasogenen und zytotoxischen Anteilen

HISTORY AND ADMISSION FINDINGS: A 66-year-old woman on antihypertensive treatment was urgently admitted to a neurological/neuroradiological unit with signs of a mild brainstem syndrome and possible hypertensive crisis. INVESTIGATIONS: Magnetic resonance imaging (MRI) of the head indicated both intracellular (so-called cytotoxic) and vasogenic edema. TREATMENT AND COURSE: After antihypertensive medication all symptoms disappeared within an hour and the MRI became essentially normal. CONCLUSION: The reversible vasogenic edema was probably caused by an hypertensive encephalopathy, while the signs of focal cerebral ischemia were due to an intracellular, ultimately irreversible, edema. In this case there was evidence of both phenomena having occurred concomitantly.