MRI study shows multifocal gyral and basal ganglia diffusion restriction with no enhancement and no white matter affection. The differential diagnosis for this appearance include seizures, CO poisoning, hypoglycemia, hyperammonemia, hypoxic-ischemic encephalopathy and Creutzfeldt-Jakob disease 1.
The history and imaging features are suggestive of acute evident ischemic changes, most likely sequel to status epilepticus due to hypoglycemia. Diffusion restriction occurs in severe attacks in which sustained seizure activity, results in hypoxia and eventually cell death. Diffusion-weighted imaging has a prognostic role in status epilepticus. Unfortunately, when T2 signal elevation is associated with significant (>10%) drop in ADC values, follow-up is likely to reflect permanent damage 2.