Severe Hypoglycemic Coma Event on MRI Specific Brain Necrosis

Abstract

A 76-year-old woman with hypertension was in coma for 48 hrs, and its bed is exposed to anti-diabetic drugs, i.e., glibenclamide 100 tables/bottle leaving only 90 tables (2.5mg /piece). The patient had no exposure to carbon monoxide, and no history of diabetes mellitus and cardiac arrest. She used to live alone, the patient was unconscious for two days, only then discovered she fell ill, and then she was given 50 ml of sugar water oral. Unfortunately, the patient remained in a coma. Brain CT scans were normal. Blood pressure was 153/92mmHg.The respiratory rate and SpO2 were normal. She had a Glasgow coma score (GCS) of E1M4V1 with symmetry pupils (diameter 1.5mm), no light reflex, corneal reflex, and extraocular movements. On admission, laboratory blood glucose was 8.6 mmol/l. Electrolytes, liver and renal function was normal. ECG revealed normal. On the second day of hospital admission, brain DWI revealed diffuse high signals on the cerebral cortex bilaterally, hippocampus, and basal ganglia ( Figure 1 A and B). After four days of admission, the patient was still in deep coma and phlegm, so the tracheotomy breathing was performed. After five days, the patient was into a vegetative state, and she was discharged after 21 days. On follow-up 2 months later, the patient was a persistent vegetative state. Severe Hypoglycemic Coma Event on MRI: Specific Brain Necrosis