What is your differential based on the imaging finding?
1) Diffuse brainstem glioma, 2) Acute brainstem infarction, 3) Osmotic myelinolysis
While reviewing the patients medical record, you note that her systolic pressure is above 200. You also not that her systolic pressure was around 100 just 1 week prior. What else should you add to your differential?
Hypertensive brainstem encephalopathy.
Axial noncontrast CT at the level of the pons demonstrates diffuse hypodensity. This was noted to extend from the upper pons to the superior cerebellar hemispheres. Additionally, the adjacent ambient and basal cisterns are disproportionately small relative to the degree of global cerebral volume loss, suggestive of edema.
The remainder of the brain was unremarkable..