Bitemporale CT-Hypodensie bei Hypoglykämie

Acute symptomatic hypoglycaemia mimicking ischaemic stroke on imaging: a systemic review

“…The second new patient that we present (Figure 2) was imaged within 9 hours of symptom onset, showed mild generalised cerebral swelling and bilateral patchy reduction in grey matter attenuation. Amongst patients imaged sequentially with CT, lesions became more apparent on day 2 or thereafter [2,3,5,6,9,13,15-18,20,22,26]. Our first new case, imaged at 14 days after initial presentation, showed unilateral cortical low attenuation and swelling.…”

“…Five papers described CT imaging only [2-6], 21 papers described both CT and MR [7-27], and 16 described MR only [28-43] (Table 1). One paper described 17 patients, four papers described between one and four patients and 37 papers described only one patient.…”

“…46 in total, presented with coma and had poor outcome of death [5,7,11,15,17,24,27,34,36,43], persistent vegetative state [2,3,12,13,16,19,20,39,42], or limited recovery with severe long-term neurological deficits [9,22,23,26,42]. Where recorded, glucose levels at presentation ranged from 10 mg/dl to 60 mg/dl (mean 24 mg/dl), and duration of hypoglycaemia was greater than 6 hours in all but two cases [24,34].…”

“…Generalised cerebral swelling was also described [6,16,17,19,26]. Lesions were typically distributed in the basal ganglia [7,11-13,15,16,20,23,26,39,42], or cerebral cortex [2,3,6,9,11,15-17,19,20,22,24,26,27,34,36,42], with some involvement of the hippocampi [7,9,13,15-17,22,42]. Cortical lesions were seen more frequently in the occipital and temporal lobes [2,3,6,9,11,15-17,19,20,22,24,27,34], but frontal and parietal cortical lesions also occurred either in addition to [6,11,16,19,20,27,34,42,43] or in the absence of temporal and occipital cortical lesions [26,36,42].…”

“…Other less common patterns included bilateral diffuse periventricular restricted diffusion [5,24,27,33,42], diffuse cortical diffusion restriction [24], or large pontine lesions [5]. All patients who survived and had follow-up imaging at least 25 days after the acute hypoglycaemic episode showed diffuse cerebral atrophy [2,3,6,12,13,16,17,19,24,26,36]. …”