Introduction Hypertensiveencephalopathyisaseriousconditionwith rapidly progressing signs and symptoms that include headache, seizures, vomiting, visual disturbances, and altered mental status [1, 2]. CT and MR imaging show characteristicallylowattenuation/T1signalandincreased T2 signal predominantly in the occipital and parietal white matter. Similar clinical and radiological findings have been reported in patients with pre-eclampsia/ eclampsiasyndrome,andlupusnephritis,andinpatients onimmunosuppressivedrugtherapysuchascyclosporin A, tacrolimus, and interferon alpha-2 [1, 2, 3, 4]. Some authors have therefore suggested the name ‘‘reversible posterior leukoencephalopathy syndrome’’ for this con- dition which also includes hypertensive encephalopathy [2].Themainfinding–unspecifiedposteriorwhite-matter oedema[5,6]–isseenonconventionalMRIasincreased Neuroradiology (2002) 44: 299–304 DOI 10.1007/s00234-001-0721-7 DIAGNOSTIC NEURORADIOLOGY P.C. Sundgren B. Edvardsson S. Holta ° s Serial investigation of perfusion disturbances and vasogenic oedema in hypertensive encephalopathy by diffusion and perfusion weighted imaging Received: 20 July 2001 Accepted: 2 October 2001 Published online: 16 February 2002 Ó Springer-Verlag 2002 This study was supported in part by grants from The Swedish Medical Research Council P.C. Sundgren (&) ® S. Holta ° s Department of Diagnostic Radiology, University Hospital of Lund, Lund, Sweden E-mail: sundgren@umich.edu B. Edvardsson Department of Neurology, University Hospital of Lund, Lund, Sweden Present address: P.C. Sundgren Department of Radiology, University of Michigan Hospitals, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0030, USA e-mail: sundgren@umich.edu Present address: S. Holta ° s Department of Diagnostic Imaging, King Fahd Hospital, National Guard Health Affairs, Riyadh, Saudi Arabia Abstract Serial MRI including diffusion and perfusion imaging was performed in a patient with hyper- tensive encephalopathy. At admis- sion, the patient was disorientated and presented with seizures and corticalblindness.Perfusionimaging showedamarkedreductioninblood volume and flow, with correspond- ing vasogenic oedema in the occipi- tal, posterior temporal, and, to a lesser extent, frontal lobes. The clinical symptoms disappeared rapidlyfollowingtreatment,whereas thedisturbedcirculationpatternand vasogenic oedema resolved more slowly. A complete normalisation was seen after 1 year. Keywords Malignant hyperten- sion ® MRI ® MR perfusion ® MR diffusion