Presentation
A female patient with loss of consciousness since admission to the hospital.
Patient Data
Bilateral, nearly symmetrical linear streaks of increased signal intensity on FLAIR and T2WIs sequences. They involve the cerebral cortex of parietal and parieto-occipital lobes, the insula, hippocampi and basal ganglia (bilateral caudate nuclei & right lentiform nucleus). Significant diffusion restriction with marked corresponding signal drop in the ADC map is noted. No mass effect or associated cerebral edema.
Markedly increased FLAIR signal intensity of the splenium of the corpus callosum is recorded.
The right basal ganglia have an ovoid lesion following CSF signal intensity on all pulse sequences suggestive of old ischemic insult.
Well-defined cystic lesion at the nasopharynx displaying hyperintense signal on T1&T2WIs suggestive of the Tornwaldt cyst.
Case Discussion
known diabetic female presented with severe symptoms of prolonged neglected hypoglycemia as altered mental status, seizures and finally coma. The cause mainly owing to an overdose of hypoglycemic medication. Consequent occurrence of the radiological image of hypoglycemic encephalopathy in MRI examination.
Differential diagnoses are:
hypoxic-ischemic brain injury: may show symmetrical thalamic lesions
Creutzfeldt-Jakob disease (CJD): different clinical presentation
ischemic infarct: usually focal and unilateral