Hypertensive Encephalopathy Presenting as Cadasil

Abstract

Hypertensive encephalopathy is a less often clinical scenario of hypertensive emergency, typified by severe resistant hypertension and mental status changes. Besides that, Hypertensive encephalopathy is enkindled by meagre controlled primary or secondary cause of hypertension and is difficult to pin down the etiology, which can concretely affect the treatment outcome.

Furthermore we discuss regarding a young adult male who has a meagrely controlled hypertensive presenting with head ache, vomiting and behavioural changes. On examination patient had impaired recent memory with other systems being intact. Computed tomography showed diffuse cerebral edema and Magnetic resonance showed white matter hyper intensities on T2 weighted images involving subcortical white matter and temporal lobe with relative sparing of posterior lobes which is classical for CADASIL (cerebral autosomal dominant artery disease with leukoencephalopathy and subcortical infarcts). CADASIL is inherited as an autosomal dominant trait, results from a mutation on chromosome 19p13.12 involving the NOTCH 3 gene. Besides classical radiological features suggesting CADASIL, the clinical and single gene testing did not unveil the diagnosis. Despite sometimes having high blood pressure, the blood pressure dropped throughout the second week after admission. Taking the clinical improvement into consideration his diagnosis was changed to hypertensive encephalopathy. By varying clinical appearance and exhibiting seldom evident clinicoradiological separation, hypertensive encephalopathy sets itself apart. Understanding the clinical and radiological signs of hypertensive encephalopathy will aid in guiding therapy and preventing pointless and expensive studies.