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BRIEF COMMUNICATIONS: C. Solinas, R. S. Briellmann, A. S. Harvey, L. A. Mitchell, and S. F. Berkovic Hypertensive encephalopathy: Antecedent to hippocampal sclerosis and temporal lobe epilepsy? Neurology 2003; 60: 1534-1536 [Abstract] [Full text] [PDF]

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Regula Briellmann, Carlo Solinas, A. Simon Harvey, L. Anne Mitchell, Samuel F. Berkovic   (19 June 2003)

Hypertensive encephalopathy: Antecedent to hippocampal sclerosis and temporal lobe epilepsy?

Gregory Y Chang   (19 June 2003)

Reply to Chang 19 June 2003
Regula Briellmann, Neurologist, Research coordinator Brain Research Institute, Heidelberg West, Victoria, Australia, Carlo Solinas, A. Simon Harvey, L. Anne Mitchell, Samuel F. Berkovic Send Correspondence to journal: Re: Reply to Chang briellmann{at}brain.org.au Regula Briellmann, et al.	We agree with Dr Chang that the distinction between uremic encephalopathy and hypertensive encephalopathy can be difficult, and that both can result in the 'posterior leukoencephalopathy syndrome'. We suspect, but cannot prove, that our three patients had the posterior leukoencephalopathy syndrome. None had MR imaging at the time of their acute disease. They all had a clinical diagnosis of hypertensive encephalopathy. The renal disease in two of the three cases is likely to be the origin of the abrupt rise in blood pressure. In our view, this does not alter the interpretation of our findings, which is that an episode of hypertensive encephalopathy, whether or not associated with a renal disease, may be a risk factor for the development of hippocampal sclerosis.
Hypertensive encephalopathy: Antecedent to hippocampal sclerosis and temporal lobe epilepsy? 19 June 2003
Gregory Y Chang, Chief of Neurology 121st US Army Gen Hosp, Seoul, Korea Send Correspondence to journal: Re: Hypertensive encephalopathy: Antecedent to hippocampal sclerosis and temporal lobe epilepsy? gychang{at}yahoo.com Gregory Y Chang	The article by Solinas et al. [1] describes three cases of intractable seizure with hippocampal sclerosis thought to be the result of prior hypertensive encephalopathy (HTE) occuring weeks to 3.5 years earlier. Two cases had renal dysfunction, one a glomerularnephritis and the other a nephrotic syndrome. The third case had Kawasaki disease with peripheral edema but the status of renal function was not provided. Encephalopathy resulting from an acute renal failure, i.e. uremic encephalopathy, is clinically indistinguishable from HTE. Variable confusion, headache, and seizures are predominant symptoms in both. Characteristic hyperkinetic movement disorder such as asterixis and multifocal myoclonus may not be present particularly in the early stages of uremic encephalopathy.[2] Furthermore, both HTE and uremic encephalopathy may play role as renal failure is commonly accompanied by elevated blood pressure. Characteristic MRI findings of HTE, manifested by a reversible posterior cerebral leukoencephalopathy [3] or rarely a predominant posterior fossa involvement [4] is well documented and presence of these changes can be diagnostic in an appropriate clinical setting. However, none of three cases presented had MRI imaging to confirm the diagnosis of HTE. Even with the aid of MRI, clear distinction between the two entities may be difficult, as exemplified by a case published as uremic encephalopathy- induced transient MRI changes, which had typical findings of HTE. [5] Taken together, I find there is insufficient evidence to suggest HTE as the cause of hippocampal sclerosis; likewise the role of uremic encephalopathy is unclear. Note: The opinions or assertions contained herein are the private views of the author and are not to be construded as representing the views of the Department of Defense, the Department of the Army, or the Uniformed Services University of the Health Sciences. References 1. Solinas C, Briellmann RS, Harvey AS, Mitchell LA. Berkovic SF. Hypertensive encephalopathy: Antecedent to hippocampal sclerosis and temporal lobe epilepsy? Neurology 2003;60:1534-1536. 2. Raskin NH, Fishman RA. Neurologic disorders in renal failure. N Engl J Med 1976;294:143-148. 3. Hinchey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996;334:494-500. 4. Chang GY, Keane JR. Hypertensive brainstem encephalopathy: three cases presenting with severe brainstem edema. Neurology 1999;53:652-654. 5. Schmidt M. Sitter T. Lederer SR. Held E. Schiff H. Reversible MRI changes in a patient with uremic encephalopathy. Journal of Nephrology. 2001;14:424-427.