Neuroimaging in Patients with Abnormal Blood Glucose Levels

Abstract

SUMMARY:Smooth neuronal functioning requires an uninterrupted supply of energy that is provided by glucose under normal physiologic conditions. Significant variations in plasma glucose levels, be it hypoglycemia or hyperglycemia, can present with myriad clinical manifestations and may mimic stroke. At times, the diagnosis is either not apparent or not clinically suspected. Imaging can suggest the diagnosis in unsuspected cases and can help in the assessment of the extent of neuronal damage in known cases, making it vital for the neuroradiologist to be aware of both common and atypical neuroimaging findings in hypoglycemia and hyperglycemia.ABBREVIATIONS: GABA ϭ gamma aminobutyric acid; HC-HB ϭ hemichorea-hemiballismus; NIDDM ϭ non-insulin-dependent diabetes mellitus; NKHG ϭ non-

Unilateral striatal CT and MRI changes secondary to non-ketotic hyperglycaemia

“…Hemichorea-hemiballismus refers to an involuntary, non-rhythmic movement disorder affecting one side of the body, most commonly caused by a vascular insult to the contralateral basal ganglia. Other causes include neoplasm, cerebral infection and systemic conditions such as thyrotoxicosis and systemic lupus erythematosus 3 5 7. NKH is known to be a rare cause of this movement disorder particularly in elderly Asian patients with diabetes,4 7–9 with the incidence reported to be higher in women compared to men 4 10…”

“…This characteristic basal ganglia lesion is hyperintense in T1W with no mass effect or perilesional oedema in the majority of reported cases in the literature 1–11. On T2W MRI, the signal changes are reported to be variable, with the lesions appearing either hypointense, isointense or hyperintense,1 7 with hypointensity predominating in many reports 8 10 11. The features of restricted diffusion7 8 10 and signal loss on gradient echo have also been reported 7.…”

Diabetic Striatopathy in Childhood: A Case Report

“…Other options include neuroleptics, dopamine release inhibitors, benzodiazepines, or anticonvulsants. 2,3 The radiologic course may be delayed, with normalization of the images only after a prolonged period of time, ranging from a few weeks to 6 years. 4 This clinical presentation seems extremely rare in children.…”

“…Its decreased concentration leads to an increase in thalamocortical activity, causing abnormal movements like HH. 3 In most cases, hyperglycemia associated with diabetic striatopathy is nonketotic and is therefore not complicated by acidosis at diagnosis. This fact may explain the patient's tolerance to chronic hyperglycemia, likely to be necessary to cause the aforementioned pathologic changes in the basal ganglia.…”

A Rare Case of Viagra Induced Toxic Encephalopathy

“…In case of hypoglycemia, white matter involvement is regarded as earlier findings. Direct toxicity of aspartate are well known pathomechanism in these patients (7). Referring to other metabolic encephalopathy which showed similar imaging finding, NO related direct toxicity can be a possible pathomechanism in Viagrainduced encephalopathy.…”