Presentation
This patient presented with acute encephalopathy and psychomotor disorders. Hypoglycemia, with organic acidemia, ketonuria, and hyperammonemia were found at examination.
Patient Data
The brain CT study demonstrates slightly symmetrical areas of hypodensities in the lentiform nucleus.
Brain MRI shows a bilateral and symmetrical abnormal hyperintense signal on T2/Flair in the head of the caudate nucleus, the lentiform nucleus, and the cerebral peduncle. There is diffusion restriction involving these regions, characterized by hyperintensities on diffusion-weighted – DWI (B-1000), with corresponding decreased intensities on the ADC map.
Impression:
By allying these imaging patterns with clinical and laboratory findings, it is possible to reach a hypothesis of hypoglycemic encephalopathy.
Case Discussion
Hypoglycemic encephalopathy is a metabolic encephalopathy, that results from an imbalance between the supply and the use of glucose by brain cells, and occurs due to hypoglycemia 1-4. Cerebral MRI, especially DWI, is an important tool for the diagnosis and predictive of prognosis of this condition 1,2,4-6.
This case illustrates hypoglycemic encephalopathy, with the typical medical history and blood indicators, combined with MRI findings, with DWI giving the best clue to the diagnosis. This child had a good outcome, and his symptoms improved after intravenous glucose therapy.
Case courtesy
- Erick Cavalcante, MD - PGY-3, Radiology resident, Department of Radiology
- Bianca Madero, Neuro pediatrician, Department of Pediatrics
- Antonio Rodrigues de Aguiar Neto, MD - Radiologist, Department of Radiology
Hospital da Restauração – Recife, PE – Brazil
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