Hypoglycemic encephalopathy

Case contributed by Dr Antonio Rodrigues de Aguiar Neto

Presentation

This patient presented acute encephalopathy with psychomotor disorders. The examination found decreased blood glucose – hypoglycemia, with organic acidemia, ketonuria, and hyperammonemia.

Patient Data

Age: 09 months
Gender: Male
CT

The brain CT study demonstrates slightly symmetrical areas of hypodensities in the lentiform nucleus. 

MRI

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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Case information

rID: 74702
Published: 3rd Mar 2020
Last edited: 4th Mar 2020
Inclusion in quiz mode: Included
Institution: Real Hospital Português de Pernambuco - Recife, PE - Brazil

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