జర్నల్ ఆఫ్ క్లినికల్ కేస్ రిపోర్ట్స్

Hypertensive Brainstem Encephalopathy Mimicking Peritumoral Edema after Gamma Knife Radiosurgery for Cerebellopontine Angle Meningioma: A Case Report

Abstract

 Young Goo Kim1, Won Seok Chang2, Hyun Ho Jung2*, Jin Woo Chang2 and Yong Gou Park2

An 83-year-old man presented with hypertensive brainstem encephalopathy manifesting as general weakness, dysarthria, gait disturbance, urinary incontinence, and decreased cognitive function. The patient had a history of gamma knife radiosurgery (GKR) for cerebellopontine angle (CPA) meningioma 10 years prior. Compared with previous magnetic resonance (MR) imaging results, a recent MR image revealed massive brainstem hyperintensity in T2-weighted images, not in the parieto-occipital lobes. The lesions were nearly completely resolved several days after normalization of the blood pressure. Isolated hypertensive brainstem encephalopathy without concomitant typical parieto-occipital abnormalities are unusual and the diagnosis is challenging especially after gamma knife radiosurgery for cerebellopontine angle meningioma. We describe a patient with hypertensive brainstem encephalopathy that was initially confused with peritumoral edema.