Hypoglycemic brain injury

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 stem.

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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Case information

rID: 25687
Case created: 3rd Nov 2013
Last edited: 25th Oct 2017
Inclusion in quiz mode: Included

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