Hypoglycemic encephalopathy

Case contributed by Dr Nikos Karapasias

Presentation

History of sulfonylurea abuse presenting with hypoglycemic coma.

Patient Data

Age: 30 years
Gender: Male
mri

Diffuse damage of the cortex and bilateral basal ganglia (caudate, globus pallidus and putamen), with sparing of the cerebellum, subcortical white matter, thalami and the brain stem.

T1: Diffuse low signal intensity lesions at T1-weighted image involving the cortex.

T2: Diffuse high signal intensity lesions at T2-weighted image at the cortex, caudate, globus pallidus and putamen. Note that the damage spares the thalami, cerebellum and hypothalamus.

Some contrast enhancement of affected areas.

Case Discussion

The neurological manifestations complicated by profound hypoglycemia range from reversible focal deficits to irreversible coma. The cortex, basal ganglia, and hippocampus seem to be the brain tissues most vulnerable to hypoglycemia The thalami, cerebellum, and hypothalamus are typically unaffected. Involvement of the caudoputamen and basal ganglia may portend a poor prognosis.

The localized lesions represent tissue degeneration, including some combination of selective neuronal death, proliferation of astrocytic glial cells, paramagnetic substance deposition, and/or lipid accumulation.

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