VISUAL HALLUCINATIONS IN A CASE OF REVERSIBLE HYPERTENSION-INDUCED BRAIN EDEMA

Visual hallucinations are commonly associated with seizures, drug effe cts, psychiatric disorders, or visual loss as 'release' phenomena. We report the case of a previously healthy 65-year-old woman, who was adm itted to hospital with intermittent headache episodes accompanied by c omplex visual hallucinations. During these episodes the patient's bloo d pressure was 220/120 mmHg. In between symptomatic episodes she had n o complaints and felt healthy. The neurological and ophthalmological e xaminations were normal but cerebral magnetic resonance imaging (MRI) showed multiple white matter abnormalities in the parieto-occipital re gions. Rapid reversal of the symptoms and imaging abnormalities occurr ed concurrently with lowering of blood pressure. The history and the f indings were similar to those recently described in the clinicoradiolo gical 'posterior leukoencephalopathy' syndrome. Different pathogenic m echanisms are discussed. Eur J Neurol 5:615-618 (C) 1998 Lippincott Wi lliams & Wilkins.