Hypertensive encephalopathy with obstructive hydrocephalus

We present a 33-year-old man who had hypertensive encephalopathy accompanied by obstructive hydrocephalus. The patient presented with headache subsequent to a hypertensive emergency. MR imaging revealed evidence of brainstem and bilateral cerebellar encephalopathy that resolved completely. Resolution of the cerebellar edema also led to improvement of the hydrocephalus.