RESUMEN
The cerebral hemispheres show prominent involvement in hypertensive encephalopathy far more frequently than the brainstem. Two patients with severe paroxysmally accelerated hypertension associated with brainstem hyperintensity in T2-weighted magnetic resonance images are presented. Both present hyperintense lesions improved dramatically in appearance after stabilization of blood pressure. Extreme acceleration of hypertension may be essential for breakdown of autoregulation in the brainstem circulation. The marked clinicoradiologic dissociation ruled out major brainstem infarction and made tumor unlikely.
Asunto(s)
Tronco Encefálico/patología , Encefalopatía Hipertensiva/diagnóstico , Imagen por Resonancia Magnética , Adulto , Presión Sanguínea/efectos de los fármacos , Hemorragia Cerebral/diagnóstico por imagen , Confusión/etiología , Confusión/psicología , Cefalea/etiología , Humanos , Encefalopatía Hipertensiva/complicaciones , Encefalopatía Hipertensiva/tratamiento farmacológico , Encefalopatía Hipertensiva/fisiopatología , Inyecciones Intravenosas , Masculino , Nitroprusiato/administración & dosificación , Nitroprusiato/uso terapéutico , Tomografía Computarizada por Rayos X , Vasodilatadores/administración & dosificación , Vasodilatadores/uso terapéutico , Verapamilo/uso terapéuticoRESUMEN
Intracranial germinoma arising primarily in the midbrain is extremely rare. We present the first reported case of cystic midbrain germinoma that lacked evident solid components and mimicked a midbrain glioma. In a 22-year-old man with headache and diplopia, magnetic resonance imaging showed a ring-enhancing lesion in the midbrain. The preoperative diagnosis included brain stem glioma, metastasis, and neuroepithelial cyst. A neuroendoscopic biopsy specimen provided a histologic diagnosis of germinoma. The patient responded well to chemotherapy and radiotherapy. The case illustrates the diagnostic value of neuroendoscopic biopsy in the differential diagnosis of brainstem lesions in adult. The possibilities considered should now include germinoma.