Hypoglycemic encephalopathy

Case contributed by Dr Anar Kazimov

Presentation

Decreased conscious state. Patient previously well. No history of diabetes or medications other than Prozac.

Patient Data

Age: 30 years
Gender: Female
Modality: MRI

Diffusion restriction in splenium corpus callosum, bilateral posterior limb of internal capsule is noted. 

Modality: MRI

Exactly 1 month later we see that the restricted diffusion in splenium corpus callosum and posterior limb of internal capsules is totally resolved. 

Case Discussion

On biochemical examination, blood glucose level was 32 mg/dL and T3, T4 and anti-TSH were high. The only medication the patient was on was Prozac, which has been associated with hypoglycaemia. 

Hypoglycemia is the sudden decrease in serum glucose level <50 mg/dL. In severe cases of hypoglycemia, the commonly affected sites are cerebral cortex, hippocampus and basal ganglia. In evaluating severe hypoglycemic encephalopathy, DWI should be used. Undiagnosed insulinoma, sepsis, renal or hepatic failure can also induce hypoglycemia. Hypoglycemia can cause several neurologic symptoms including memory loss, transient motor deficits, a persistent vegetative state, and in rare cases death. In hypoglycemic encephalopathy cases, the lesions show reversible cytotoxic oedema at the cerebral cortex, hippocampus, splenium of the corpus callosum (boomerang sign), internal capsule, and cerebral white matter.

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Case Information

rID: 49014
Case created: 5th Nov 2016
Last edited: 19th Dec 2016
Inclusion in quiz mode: Included

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