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A 53-year-old man presented with a 4-week history of bilateral retrobulbar headache and blurred vision. His blood pressure was 220/135 mm Hg; his neurologic examination was unremarkable. He had no history of hypertension and was not taking any medication for its treatment. Fundus examination showed bilateral disk edema, lipid exudate (Panel A, short arrow), cotton-wool spots (Panel A, long arrow), a swollen optic nerve (Panel B, long arrow), and retinal hemorrhages (Panel B, short arrow). Magnetic resonance imaging of the brain showed an isolated hyperintense abnormality on fluid-attenuated inversion recovery (FLAIR) images in the pons and midbrain (Panel C, arrow) that did not enhance with gadolinium (Panel D, arrow). Good control of blood pressure was established, and the appearance of the fundus and brain stem returned to normal (Panel E, arrow) 4 months later.
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