Severe Hypoglycemia Associated with an Illegal Sexual Enhancement Product Adulterated with Glibenclamide: MR Imaging Findings

Abstract

Diffusion-weighted MR imaging findings in patients with severe hypoglycemia showed typical lesions in the hippocampus and cerebral cortex, but the caudate nucleus and basal ganglia were involved in only the most severely affected patient. The splenium of the corpus callosum and internal capsule were also abnormal in three patients, and unilateral cortical lesions could be distinguished from acute ischemic stroke by the pattern of involvement and MR angiographic, perfusion, and spectroscopic findings.

Diffusion MR Imaging of Hypoglycemic Encephalopathy

“…5,7,16 However, if lesions are detected in the cerebral cortex, BG, or hippocampus and the lesions do not regress on second imaging, the outcome will be poor. 2,5,9,18,28 In our study, prognosis of patients was similar, as reported previously. However, there were some differences.…”

Severe Hypoglycemic Coma Event on MRI Specific Brain Necrosis

“…Our patient's DWI showed only a symmetrical gray matter injury, including bilateral temporal occipital cortex, basal ganglia, and hippocampus; whereas white matter not be affected. This selective neuronal necrosis in the gray of brain on DWI is a specific feature hypoglycemic brain injury [5,6]. However, glucose deprivation is different than the cerebral circulation stops.…”

“…For instance, some prolonged hypoglycemia coma associated with lesions of the internal capsule, corona radiata and cortex have been reversed by raising glucose [12][13][14]. Lesions of the bilateral basal ganglia may survive in a persistent vegetative state, [5,6] even with a poor outcome and death [13,15].…”

Neuroimaging in Patients with Abnormal Blood Glucose Levels

“…6,11,15,50 Hypoglycemia was initially reported to predominantly involve the cortex, neostriatum, and hippocampus. 6,11,12,54,57 However, many authors have also reported predominant WM involvement, mainly affecting the centrum semiovale, corona radiata, internal capsule, an splenium of the corpus callosum. 7,11,12,53,54,56 In fact, involvement of the WM is now thought to be earlier and more common than gray matter involvement.…”

“…6,7,12,15,53 The extent of these abnormalities depends on severity and duration of hypoglycemia. 6,49,52,57 Changes are usually bilateral, though bilaterally asymmetric, or, rarely, unilateral lesions, may occur. 11,52,57 Reduction in ADC values has been shown to follow establishment of cerebral isoelectricity, a process that may be asynchronous.…”