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Published on: November 9, 2018
Early diffusion MR imaging findings and short-term outcome in comatose patients with hypoglycemia
1Department of Neurology and Stroke Center, Hiratsuka Kyosai Hospital, 9 –11 Oiwake, Hiratsuka 254-8502, Japan. johkura-k@kkr.hiratsuka.kanagawa.jp
Background And Purpose:
The relationship between the MR imaging features and clinical outcomes in patients with hypoglycemic encephalopathy has always been evaluated retrospectively. The aim of this study was to prospectively evaluate whether MR imaging features of patients presenting with hypoglycemic coma are predictive of short-term (1-week) outcomes.
Materials And Methods:
Subjects were 36 consecutive patients with hypoglycemia who were in a comatose state on arrival at our hospital from April 2006 to March 2010. MR imaging findings on arrival in relation to the patients' clinical course after glucose infusion were evaluated.
Results:
Thirteen of the 36 patients showed no MR imaging abnormalities on arrival. DWI revealed focal lesions involving the internal capsule in 13 patients and lesions involving bilateral hemispheric white matter in 10 patients. After glucose administration, the patients without lesions and patients with focal internal capsule lesions recovered completely within 1 day. However, patients with diffuse white matter lesions did not recover even within 1 week despite glucose administration. There was no statistical difference in the initial blood glucose levels among patients with the various types of MR imaging findings.
Conclusions:
On early MR imaging, hypoglycemic brain injury may first appear in the internal capsule and then spread into the hemispheric white matter. The absence of a lesion or the presence of a focal internal capsule lesion may suggest a good outcome. However, diffuse hemispheric white matter lesions may indicate a poor 1-week outcome.
Insights
Early MR imaging can predict outcomes in hypoglycemic coma. Absence of lesions or focal internal capsule lesions suggest good recovery, while diffuse white matter lesions indicate poor short-term outcomes.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Hypoglycemic encephalopathy outcomes are typically assessed retrospectively.
- Prospective evaluation of MR imaging in hypoglycemic coma is needed.
Purpose of the Study:
- To prospectively assess if MR imaging features predict short-term outcomes in patients with hypoglycemic coma.
- To correlate MR imaging findings with clinical recovery after glucose administration.
Main Methods:
- 36 comatose patients with hypoglycemia were prospectively studied.
- MR imaging, including DWI, was performed on arrival.
- Findings were correlated with clinical course after glucose infusion.
Main Results:
- 13 patients had no MR imaging abnormalities.
- 13 patients showed focal internal capsule lesions on DWI.
- 10 patients had diffuse hemispheric white matter lesions.
- Patients without lesions or with focal internal capsule lesions recovered within 1 day.
- Patients with diffuse white matter lesions did not recover within 1 week.
- No significant difference in initial blood glucose levels was observed across imaging groups.
Conclusions:
- Hypoglycemic brain injury may initially affect the internal capsule, spreading to hemispheric white matter.
- Absence of lesions or focal internal capsule lesions on early MR imaging predict good outcomes.
- Diffuse hemispheric white matter lesions on early MR imaging predict poor 1-week outcomes.
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