Localized reversible high signal intensities on diffusion-weighted MRI in hypoglycemia: A study of 70 cases

Katoh, Masahito; Yamada, Masami; Aoki, Takeshi; Abumiya, Takeo; Imamura, Hiroyuki; Aida, Toshimitsu

doi:10.4103/1793-5482.144196

Cited by 7 publications

(5 citation statements)

References 12 publications

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“…Hypoglycemia may also be associated with RESLES lesions in neonates [64], and in adults [65]. AVP also appears to play a role in glucose homeostasis, insulin resistance and diabetes mellitus (DM).…”

Section: Pathophysiological Considerationsmentioning

confidence: 99%

“…Although most RESLES lesions disappear following clinical remission and have a favorable outcome, two cases have been described in which these lesions persisted 6-9 months, independent of clinical improvement [69]. A delay in treatment may, however, may lead to irreversible and prolonged consciousness disturbance [65].…”

Section: Katoh Et Al Found That 4/70 Patients With Hypoglycemiamentioning

confidence: 99%

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The splenium of the corpus callosum: embryology, anatomy, function and imaging with pathophysiological hypothesis

Blaauw

Meiners

2020

Neuroradiology

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Background and purpose The splenium of the corpus callosum is the most posterior part of the corpus callosum. Its embryological development, anatomy, vascularization, function, imaging of pathology, possible pathophysiological mechanisms by which pathology may develop and the clinical consequences are discussed. Methods A literature-based description is provided on development, anatomy and function. MR and CT images are used to demonstrate pathology. The majority of pathology, known to affect the splenium, and the clinical effects are described in three subsections: (A) limited to the splenium, with elaboration on pathophysiology of reversible splenial lesions, (B) pathology in the cerebral white matter extending into or deriving from the splenium, with special emphasis on tumors, and (C) splenial involvement in generalized conditions affecting the entire brain, with a hypothesis for pathophysiological mechanisms for the different diseases.Results The development of the splenium is preceded by the formation of the hippocampal commissure. It is bordered by the falx and the tentorium and is perfused by the anterior and posterior circulation. It contains different caliber axonal fibers and the most compact area of callosal glial cells. These findings may explain the affinity of specific forms of pathology for this region. The fibers interconnect the temporal and occipital regions of both hemispheres reciprocally and are important in language, visuospatial information transfer and behavior. Acquired pathology may lead to changes in consciousness. Conclusion The development, location, fiber composition and vascularization of the splenium make it vulnerable to specific pathological processes. It appears to play an important role in consciousness. AbbreviationAC anterior commissure ACC agenesis of the corpus callosum ADEM acute disseminated encephalomyelitis ADH anti-diuretic hormone AED anti-epileptic drugs AVP arginine-vasopressin CC corpus callosum CLOCC cytotoxic lesions of the corpus callosum DLBCL diffuse large B cell lymphoma GBM glioblastoma multiforme HC hippocampal commissure HIE hypoxic ischemic encephalopathy MERS mild encephalitis/encephalopathy with a reversible splenial lesion PCNSL primary central nervous system lymphoma RESLES reversible splenial lesions syndrome

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Section: Pathophysiological Considerationsmentioning

confidence: 99%

Section: Katoh Et Al Found That 4/70 Patients With Hypoglycemiamentioning

confidence: 99%

The splenium of the corpus callosum: embryology, anatomy, function and imaging with pathophysiological hypothesis

Blaauw

Meiners

2020

Neuroradiology

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“… 4) In comatose patients with hypoglycemia, hyperintensity lesions on DWI, corresponding to hypointense signals on the ADC map, were seen in 9%–64%. 5 , 6) Of these, the posterior limb of the internal capsule is one of the most affected areas in the early period.…”

Section: Discussionmentioning

confidence: 99%

“…Blood glucose testing should be performed in patients, who present with acute neurological impairment. 3 , 6) …”

Section: Discussionmentioning

confidence: 99%

Severe Hypoglycemia-induced Right Hemiparesis with Reversible Diffusion Restriction in the Left Internal Capsule Due to Combination Therapy Using Disopyramide and Clarithromycin

Sugita

Koyanagi

Oda

et al. 2018

NMC Case Report Journal

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Severe hypoglycemia is known to cause acute focal neurological symptoms. In cases with a medical history of diabetes mellitus (DM), the diagnosis and treatment of hypoglycemia-induced neurological symptoms are simple. However, severe hypoglycemia can occur in patients who are not taking hypoglycemic agents such as insulin or long-acting sulfonylurea drugs. We describe a 95-year-old man with sudden onset of right hemiparesis who showed high signal intensity on diffusion-weighted imaging involving the left internal capsule with corresponding reduced apparent diffusion coefficient hypointensity. Laboratory findings revealed severe hypoglycemia (27 mg/dl). However, he was not taking insulin or long-acting sulfonylurea drugs but disopyramide and clarithromycin had been administered. In addition, he had kidney dysfunction with an estimated glomerular filtration rate (GFR) of 42.9 ml/min/1.73 m2. After the blood glucose level was normalized, the left hemiparesis completely recovered and abnormal findings of magnetic resonance imaging (MRI) study also became normal. A combination of disopyramide and clarithromycin may cause severe hypoglycemia-induced neurological symptoms particularly in patients with kidney dysfunction. Even in a patient with sudden-onset hemiparesis and no history of DM, the possibility of hypoglycemia-induced neurological deficit should be considered.

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“…Регистрируется высокая интенсивность сигнала в коре головного мозга, а также в гиппокампе, головке хвостатого ядра, чечевицеобразном ядре и мозолистом теле. Сообщается, что гипогликемическое повреждение головного мозга начинается c белого вещества в области проводящих путей, таких как внутренняя капсула, и распространяется на весь мозг, включая серое вещество [50,51].…”

Section: нейрокогнитивные и церебральные измененияunclassified

Hypoglycemia in type 2 diabetes mellitus patients — cerebral, cognitive, psychosocial and clinical aspects

2022

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The review article describes modern approaches to hypoglycemia in diabetes mellitus (DM) patients, its clinical and laboratory diagnostics, and its current classification. Hypoglycemia has the highest impact on cardiovascular morbidity and mortality, including stroke. Cerebral damage in neuroglycopenia, as well as neurological aspects in this group of patients, are discussed. The authors describe glycopenia’s influence on cerebral metabolism, counter-regulatory response, and impaired hypoglycemia recognition, as well as modern neuroimaging techniques that may enhance differential diagnostics in complex cases. The epidemiology of neurocognitive disorders in DM patients and their association with hypoglycemic conditions is outlined, together with psychosocial aspects of its consequences — both for the patient and relatives and for the medical professionals. The search for ways to reduce the burden of hypoglycemia from the standpoint of an effective and safe strategy for treating patients with type 2 diabetes does not lose its relevance, and therefore data on the prevalence of hypoglycemic conditions of varying severity when using certain classes of hypoglycemic drugs are presented. A therapeutic approach that maximizes metabolic control while reducing hypoglycemia to a minimum may determine further possibilities for personalized DM management.

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Localized reversible high signal intensities on diffusion-weighted MRI in hypoglycemia: A study of 70 cases

Cited by 7 publications

References 12 publications

The splenium of the corpus callosum: embryology, anatomy, function and imaging with pathophysiological hypothesis

The splenium of the corpus callosum: embryology, anatomy, function and imaging with pathophysiological hypothesis

Severe Hypoglycemia-induced Right Hemiparesis with Reversible Diffusion Restriction in the Left Internal Capsule Due to Combination Therapy Using Disopyramide and Clarithromycin

Hypoglycemia in type 2 diabetes mellitus patients — cerebral, cognitive, psychosocial and clinical aspects

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