Acute hypertensive encephalopathy presenting with a partial third nerve palsy: image findings

Description

A middle-aged patient presented with partial third nerve palsy with pupillary sparing; the time of onset was unclear. A collateral history revealed that the patient had suffered gradual memory impairment, difficulty performing tasks and word finding problems in the preceding months.

The patient's blood pressure on admission was 210/140 mm Hg; subsequently malignant hypertension was diagnosed. There was no significant medical history and the patient did not take any prescription medications. There was a family history of stroke.

On examination there was partial third nerve palsy, pupils were equal and reactive to light. Exophthalmos was evident bilaterally. Tone was mildly increased symmetrically, in the upper and lower limbs. There was central obesity.

An MRI of the brain showed patchy foci of acute ischaemic change throughout the cerebrum with associated restricted diffusion (figures 1 and 2). There were multifocal small parenchymal haemorrhages in the basal ganglia,...

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