Reversible hyperintensity lesion on diffusion-weighted MRI in hypoglycemic coma

Aoki, Takeshi; Sato, Tomoe; Hasegawa, Kazuo; Ishizaki, Ryuji; Saiki, Masaaki

doi:10.1212/01.wnl.0000130181.05016.68

Cited by 88 publications

(82 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[1][2][3] Neuropathologic studies have demonstrated that the cerebral cortex, hippocampus, and BG are commonly affected sites in severe hypoglycemia; however, the cerebellum and brain stem are usually spared. [4][5][6][7][8][9][10] In addition, unlike hypoxic damage, the occipital cortex, dorsofrontal cortex, and hippocampus may be more resistant to prolonged hypoglycemia. 9 Some studies have described MR imaging of hypoglycemic brain injury, though these studies have usually been confined to case reports; in most of the reported studies, DWI is useful in evaluating severe HE.…”

mentioning

confidence: 99%

Diffusion MR Imaging of Hypoglycemic Encephalopathy

Kang¹,

Jeon²,

Choi³

et al. 2009

AJNR Am J Neuroradiol

126

135

View full text Add to dashboard Cite

mentioning

confidence: 99%

Diffusion MR Imaging of Hypoglycemic Encephalopathy

Kang¹,

Jeon²,

Choi³

et al. 2009

AJNR Am J Neuroradiol

126

135

View full text Add to dashboard Cite

“…Aoki et al described reversible abnormalities in diffusionweighted MRI 10 days after glucose infusion 9 . In fact, as the reversible brain-imaging abnormalities and hemiparesis caused by hypoglycemia can mimic a transient ischemic attack or stroke 10 , the determination of blood glucose levels, the effects of its infusion and the comparison of MRI images on the day of admission to one taken several days after glucose infusion can be useful tools to make differential diagnosis 9 .…”

Section: Discussionmentioning

confidence: 99%

“…Another considerable hypothesis is the disruption of protein synthesis in the superficial layers of the cortex, in the basal ganglia, and hippocampus 1,9 . On the other hand, the cerebellum and brain stem are less affected by this mechanism because they have effective strategies to transport glucose 9 .…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, the cerebellum and brain stem are less affected by this mechanism because they have effective strategies to transport glucose 9 . Hypoperfusion in injured areas of the cortex may occur for the selective regional loss of autoregulation in the cortex after hypoglycemia 1 .…”

Section: Discussionmentioning

confidence: 99%

“…Mainly the f-MRI can predict the patient' s evolution for its sensitivity to detect the cytotoxic damage 9 . It has been described that the most patients with lesions on conventional MRI have a poor functional prognosis 14 .…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Hemiparesis and lateralized cortical lesions associated to severe hypoglycemia

Batista

Almeida

Avelino³

et al. 2008

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

Severe hypoglycemia may occur as a complication of insulin therapy or as a consequence of accidental or suicidal insulin injections 1 . It may result in a variety of neurological symptoms such as focal deficits, epileptic crisis, coma state and death. There is a relative rarity of reports about hypoglycemic-induced brain lesions 2 . In newborns, the parieto-occipital region is the most affected 3 . In adults, there is a greater variability, with reports of lesions in basal ganglia, hippocampus, temporal and occipital gray matter, insula cortex, corona radiata and splenium of the corpus callosum 1,4 .The aim of this study is to report the case of a patient presenting coma, with left hemiparesis and brain lesions detected by computerized tomography scan (CT) and conventional magnetic resonance imaging (MRI). He had insulin-dependent diabetes mellitus and had a record of severe hypoglycemic episode. CASEA 31-year-old male, insulin-dependent diabetic patient, which left his home after a family brawl, at about 8 o'clock p.m when he had a capillary glycemia, which resulted 212 mg%. He was met unconscious in the morning by his wife at a car, near their home, with many empty flasks and syringes of insulin. The last register of glycaemia in the dosimeter was 34 mg%, at about 3 o' clock a.m.He was taken to the hospital by the urgency medical care service. On admission, he showed stable vital signs and capillary glycemia of 82 mg%. On neurological examination, the patient was comatose and with left hemiparesis. He was submitted to orotracheal intubation, mechanical ventilation and supportive care. A cerebral computerized tomography (CT) scan showed a slight parietal high-density area and MRI (Figure) showed cortical lesions with hypointensity and hyperintensity in T1-and T2-weighted images, respectively, affecting the insula bilaterally, but more evident on the right side, the hippocampus (more accentuated on the right side), the medial part of frontal lobe, bilaterally but more accentuated on the right side, and the parietal lobe, almost exclusively on the right side.

show abstract

Encephalopathy (delirium) due to Systemic Disease

Weathers

2013

Neurological Disorders Due to Systemic Disease

View full text Add to dashboard Cite

Reversible hyperintensity lesion on diffusion-weighted MRI in hypoglycemic coma

Abstract: In a woman aged 73 years who recovered from hypoglycemic coma without neurologic deficit after glucose infusion, admission diffusion-weighted MRI showed the presence of hyperintensive lesions. The lesions regressed after glucose infusion.

Cited by 88 publications

References 10 publications

Diffusion MR Imaging of Hypoglycemic Encephalopathy

Diffusion MR Imaging of Hypoglycemic Encephalopathy

Hemiparesis and lateralized cortical lesions associated to severe hypoglycemia

Encephalopathy (delirium) due to Systemic Disease

Contact Info

Product

Resources

About