MRI
What is the definition of hypoglycemic encephalopathy?
Hypoglycemic encephalopathy is a metabolic encephalopathy, which results from hypoglycemia and is characterized by a decreased level of consciousness and even coma/stupor.
What are the clinical features of hypoglycemic encephalopathy?
Hypoglycemic encephalopathy is a life-threatening manifestation of hypoglycemia, in which clinical features are seizures, focal neurologic deficits, memory loss, change of mental status (confusion, loss of consciousness, coma, and even death).
What is the etiology of hypoglycemic encephalopathy?
The etiology of hypoglycemic encephalopathy is any cause of profound hypoglycemia such as an overdose of hypoglycemic medication and undiagnosed pancreatic insulinoma, or other diseases such as hepatic or renal failure or sepsis. It is most commonly a result of underlying diabetes mellitus.
What are the MRI findings of hypoglycemic encephalopathy?
The most common MRI findings are bilateral areas of increased signal on T2/FLAIR and diffusion restriction affecting the posterior limb of the internal capsule, hippocampus, head of the caudate nucleus, the lentiform nucleus and cerebral cortex, in particular parieto-occipital and insula. The splenium of the corpus callosum can be affected (boomerang sign). Restricted diffusion is commonly reversible. The cerebellum, brainstem, thalami, and white matter are usually involved in neonates and spared in adults.
How is the treatment of hypoglycemic encephalopathy?
The treatment is intravenous glucose injection and drip, associated with supportive treatments.
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.