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PICTURES IN CLINICAL MEDICINE
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Diffusion-weighted Imaging Changes in a Case of Severe Hypoglycemic Encephalopathy Kumiko Miura 1, Tomoaki Kameda 2 and Masayuki Suzukawa 1 Key words: hypoglycemic encephalopathy, MRI (Intern Med 54: 989, 2015) (DOI: 10.2169/internalmedicine.54.3683)
Picutre 2.
Picutre 1.
A 75-year-old man with a history of diabetes mellitus on treatment with three oral hypoglycemic drugs was admitted to our hospital after being found unresponsive at home. Upon arrival, his blood glucose level was 11 mg/dL. The initial brain diffusion-weighted image (DWI), obtained between two and 19 hours after onset, revealed the presence of symmetric hyperintense lesions in the bilateral deep white matter (Picture 1). Five days later, new cerebral cortex lesions were found on DWI, while the previous lesions had disappeared (Picture 2). The patient died 14 days later due to pneumonia without regaining consciousness. Hypoglycemic encephalopathy often produces abnormal signals on brain DWI, especially in the cerebral cortex, hippocampus, basal ganglia and deep white matter (1). However, reports of
serial DWI changes, such as that observed in the present case, are uncommon (2). Although the exact mechanisms underlying serial DWI changes are unknown, the observations in this case may provide a basis for predicting a poor prognosis due to hypoglycemic injury. The authors state that they have no Conflict of Interest (COI).
References
１
1. Witsch J, Neugebauer H, Flechsenhar J, Jüttler E. Hypoglycemic encephalopathy: a case series and literature review on outcome determination. J Neurol 259: 2172-2181, 2012. 2. Lee CY, Liou KC, Chen LA. Serial magnetic resonance imaging changes in hypoglycemic encephalopathy. Acta Neurol Taiwan 22: 22-25, 2013.
Department of Emergency Medicine, Jichi Medical University, Japan and ２Department of Neurology, Jichi Medical University, Japan Received for publication July 16, 2014; Accepted for publication August 31, 2014 Correspondence to Dr. Kumiko Miura, [email protected] Ⓒ 2015 The Japanese Society of Internal Medicine Journal Website: http://www.naika.or.jp/imonline/index.html
989
PICTURES IN CLINICAL MEDICINE
□
Diffusion-weighted Imaging Changes in a Case of Severe Hypoglycemic Encephalopathy Kumiko Miura 1, Tomoaki Kameda 2 and Masayuki Suzukawa 1 Key words: hypoglycemic encephalopathy, MRI (Intern Med 54: 989, 2015) (DOI: 10.2169/internalmedicine.54.3683)
Picutre 2.
Picutre 1.
A 75-year-old man with a history of diabetes mellitus on treatment with three oral hypoglycemic drugs was admitted to our hospital after being found unresponsive at home. Upon arrival, his blood glucose level was 11 mg/dL. The initial brain diffusion-weighted image (DWI), obtained between two and 19 hours after onset, revealed the presence of symmetric hyperintense lesions in the bilateral deep white matter (Picture 1). Five days later, new cerebral cortex lesions were found on DWI, while the previous lesions had disappeared (Picture 2). The patient died 14 days later due to pneumonia without regaining consciousness. Hypoglycemic encephalopathy often produces abnormal signals on brain DWI, especially in the cerebral cortex, hippocampus, basal ganglia and deep white matter (1). However, reports of
serial DWI changes, such as that observed in the present case, are uncommon (2). Although the exact mechanisms underlying serial DWI changes are unknown, the observations in this case may provide a basis for predicting a poor prognosis due to hypoglycemic injury. The authors state that they have no Conflict of Interest (COI).
References
１
1. Witsch J, Neugebauer H, Flechsenhar J, Jüttler E. Hypoglycemic encephalopathy: a case series and literature review on outcome determination. J Neurol 259: 2172-2181, 2012. 2. Lee CY, Liou KC, Chen LA. Serial magnetic resonance imaging changes in hypoglycemic encephalopathy. Acta Neurol Taiwan 22: 22-25, 2013.
Department of Emergency Medicine, Jichi Medical University, Japan and ２Department of Neurology, Jichi Medical University, Japan Received for publication July 16, 2014; Accepted for publication August 31, 2014 Correspondence to Dr. Kumiko Miura, [email protected] Ⓒ 2015 The Japanese Society of Internal Medicine Journal Website: http://www.naika.or.jp/imonline/index.html
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