MR Findings of the Brain Stem in Arterial Hypertension

In their case reports, de Seze et al (1) describe edema of the brain stem in two patients with arterial hypertension. Their article once again draws attention to an often unrecognized syndrome that is potentially life-threatening. There have been earlier descriptions of brain stem edema in patients with hypertensive encephalopathy on MR images in patients with brain stem signs (2), but this is the first published with such beautiful FLAIR images.

The authors claim that the particular MR pattern helps to understand the change in hypertensive encephalopathy. In my opinion, it merely underlines the more or less accepted role of edema. The pathogenesis of hypertensive encephalopathy warrants more study, despite some excellent work in the past (3, 4). Futhermore, I would like to emphasize the life-threatening nature of hypertensive encephalopathy, especially if brain stem edema is present. Treatment is available, however, and it is well tolerated (2). Because of this, the clinician must be informed of the MR findings as soon as possible. Lastly, in order to maintain a uniform nomenclature it might have been preferable to refer to the described entity as “hypertensive encephalopathy” not only in the text but in the title of their article as well.