Hypertensive encephalopathy (HTE) usually presents with progressive headache, confusion, visual disturbance and generalised seizures and may progress to coma and death. It is a common cause of the reversible posterior leucoencephalopathy syndrome,¹ now more commonly referred to as the posterior reversible encephalopathy syndrome, as grey matter is often also involved. Cranial imaging typically reveals parieto-occipital subcortical white matter oedema. The preferential involvement of the parietal and occipital lobes is unexplained but may be linked to the relative paucity of sympathetic innervation of the posterior cerebral arterial circulation. Impairment of autoregulation of cerebral blood flow because of an uncontrolled rise in arterial blood pressure, dilatation of cerebral arterioles and endothelial dysfunction are thought to underlie the vasogenic oedema which occurs.¹ We report a rare presentation of uncontrolled hypertension with episodic vertigo and ataxia, isolated cerebellar oedema on cranial MRI and secondary obstructive hydrocephalus.

Case report

A 52-year-old man presented with a 3 week history of recurrent episodes of severe vertigo, nausea, ataxia and mild headache. The initial episodes improved spontaneously over the course of several days but onset of the third such episode led to his admission to hospital. He had experienced mild persistent bifrontal headache …