Expanding the spectrum of subacute diencephalic angioencephalopathy

J Clin Neurosci. 2016 Jan;23:8-13. doi: 10.1016/j.jocn.2015.06.016. Epub 2015 Aug 24.


We present a patient with subacute diencephalic angioencephalopathy (SDAE), a poorly understood syndrome of progressive confusion, disorientation, and dementia that rapidly deteriorates to severe encephalopathy and death. This is the seventh and most thoroughly investigated report of this exceedingly rare diagnosis to date, and we present the first evidence of a potential sentinel syndrome that may allow for earlier diagnosis and therapeutic intervention. We also review the relevant literature, and highlight new evidence that suggests that SDAE and the related disorder, subacute brainstem angioencephalopathy (SBAE), represent severe and terminal variants of posterior reversible encephalopathy syndrome (PRES). Taken together, we suggest a new understanding of SDAE/SBAE and PRES as a spectrum of hypertension-associated non-inflammatory vascular encephalopathies that are mediated by a loss of venous autoregulation, marked by cytotoxic edema, and that ultimately produce subacute-to-acute diencephalic, brainstem, and posterior fossa injuries with devastating neurologic consequences.

Keywords: Encephalopathy; Posterior reversible encephalopathy syndrome; Rare diseases; Subacute diencephalic angioencephalopathy; Vasculopathy.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged
  • Humans
  • Male
  • Posterior Leukoencephalopathy Syndrome* / diagnosis