Presentation
Found with reduced consciousness. Not seen for 2 days prior. Hypoglycemic and hypoxic on scene, with long acting insulin pen in possession. PMH impulsive overdoses, not known diabetic.
Patient Data
No acute findings on emergency department CT head. No territorial infarct, bleed or mass. Normal CSF configuration.
Diffused grey matter abnormality, with relative sparing of the Rolandic cortex and posterior fossa. Otherwise swelling and edema of the cortex, caudate and lentiform nuclei. Abnormal diffusion restriction through these involved structures.
Moderate patchy periventricular and deep white matter small vessel changes, likely pre-existing.
Normal major vascular signal voids.
Case Discussion
This case demonstrates the diffuse changes seen with hypoglycemic encephalopathy. Although the patient was hypoxic at presentation - and this will have contributed to the symptoms and imaging findings - this was deemed an intentional overdose of long acting insulin with these appearances most compatible with hypoglycemia.