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Diffusion-weighted MRI predicts prognosis in severe hypoglycemic encephalopathy.
Youichi Yanagawa1, Naoaki Isoi, Aya M Tokumaru
1Department of Traumatology and Critical Care Medicine, National Defense Medical College, 3-1 Tokorozawa, Saitama 359-8513, Japan. yanagawa@me.ndmc.ac.jp
Summary
Severe hypoglycemia after insulin injection caused brain injury. Diffusion-weighted MRI (DWI) findings on day 5 predicted poor functional outcomes, highlighting DWI
Area of Science:
- Neurology
- Radiology
- Endocrinology
Background:
- Hypoglycemia, particularly from self-administered insulin, can lead to severe neurological complications.
- Understanding the early predictors of neurological damage is crucial for patient management.
Observation:
- A 20-year-old woman presented with unconsciousness due to severe hypoglycemia.
- Diffusion-weighted MRI (DWI) revealed extensive cortical and subcortical signal abnormalities.
- Neurological deficits evolved over time, including motor and sensory impairments, and later aphasia, agnosia, and apraxia.
Findings:
- Diffusion-weighted MRI (DWI) performed 5 days post-admission showed heterogeneous high-intensity signals in the cortex and subcortex.
- These DWI findings correlated with the patient's subsequent severe neurological deficits.
- The pattern of injury, sparing motor and sensory centers initially, evolved into significant cognitive and linguistic impairments.
Implications:
- Diffusion-weighted MRI (DWI) is a valuable tool for predicting functional outcomes in severe hypoglycemia.
- Early DWI assessment can guide prognosis and therapeutic strategies for patients with insulin-induced hypoglycemia.
- This case underscores the potential for significant, long-lasting neurological sequelae following profound hypoglycemia.