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초록

Department of Neurology, Neurosurgery*, Radiology**, College of Medicine, Kangwon National University Background: Reversible posterior leukoencephalopathy syndrome associated with hypertension rarely presents with predominant involvement of the brainstem. We describe the clinical and neuroimaging features of a patient with reversible hypertensive brainstem encephalopathy. Case Report: A 41-year-old man was brought to our hospital due to altered mental state with severe arterial hypertension. Neurological examination revealed mild quadriparesis and ataxia with mental confusion. Extensive hyperintense lesions were observed in the brain stem, cerebellum and thalamus on T2 weighted images. But this lesion was not hyperintense on diffusion-weighted images. His symptoms and imaging abnormalities gradually improved within few weeks. Conclusions: Mental confusion in the setting of severe hypertension with a relative paucity of brain stem signs despite extensive neuroimaging abnormalities may support the diagnosis of hypertensive brainstem encephalopathy. Diffusion-weighted images may be helpful in distinguishing the cytotoxic edema from vasogenic edema, thus excluding the diagnosis of acute ischemic infarction.

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