The authors present a case of hypertensive encephalopathy in which CT and MR were performed. The brain stem and cerebellum were revealed as low density areas on CT and high intensity areas on T2-weighted MR images with mass effect. Slight abnormality was also noticed in the deep cerebral white matter. This distribution pattern is contrary to that described in previous reports in which cerebral white matter was mainly involved. The lesions showed definite improvement when the blood pressure was normalized. MR is more sensitive than CT, and is useful for early detection of the abnormality and follow-up study.