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Published on: September 20, 2015
Localized reversible high signal intensities on diffusion-weighted MRI in hypoglycemia: A study of 70 cases
Masahito Katoh1, Masami Yoshino1, Takeshi Aoki1
1Department of Neurosurgery, Hokkaido Neurosurgical Memorial Hospital, Sapporo, Japan.
Introduction:
It is well-known that localized reversible high signal intensities in the splenium of the corpus callosum or the basal ganglia appear on diffusion-weighted MRI in the presence of hypoglycemia. The aim of this study was to clarify the incidence and significance of such high signal intensity lesions.
Results:
We analyzed 70 cases of hypoglycemia with consciousness disturbance referred to our outpatient office. Localized reversible high signal intensities on diffusion-weighted MRI were noted in 6 cases (8.6%). They were at the splenium of the corpus callosum in four cases (5.7%), and right frontal cortex and bilateral frontal white matter in one each. Convulsions were noted in five cases, and right hemiparesis was noted in three. None of the three cases of hemiparesis showed localized reversible high signal intensities on diffusion-weighted MRI. These lesions are reversible if the patients undergo treatment without delay.
Conclusion:
The significance of these lesions is still unclear. However, when a high signal intensity lesion that is not reasonable for the symptom is detected on diffusion-weighted MRI, an immediate check of the blood sugar level is mandatory.
Insights
Localized reversible MRI lesions in the corpus callosum and basal ganglia are seen in 8.6% of hypoglycemia cases. Prompt blood sugar checks are crucial when these diffusion-weighted MRI findings appear.
Area of Science:
- Neurology
- Radiology
- Endocrinology
Background:
- Diffusion-weighted MRI (DWI) can reveal high signal intensities in the splenium of the corpus callosum or basal ganglia during hypoglycemia.
- These MRI findings are known but their incidence and significance require further clarification.
Purpose of the Study:
- To determine the incidence of localized reversible high signal intensities on DWI in patients with hypoglycemia.
- To investigate the clinical significance of these MRI lesions.
Main Methods:
- Analysis of 70 patients with hypoglycemia and disturbed consciousness.
- Review of diffusion-weighted MRI scans to identify localized reversible high signal intensities.
- Correlation of MRI findings with clinical symptoms such as convulsions and hemiparesis.
Main Results:
- Localized reversible high signal intensities on DWI were observed in 6 out of 70 cases (8.6%) of hypoglycemia.
- Lesions were most commonly found in the splenium of the corpus callosum (5.7%), with other cases in the frontal cortex and white matter.
- While 5 patients experienced convulsions and 3 had hemiparesis, none of the hemiparesis cases showed these specific MRI lesions.
Conclusions:
- The precise significance of these reversible DWI lesions in hypoglycemia remains uncertain.
- The presence of unexplained high signal intensity lesions on DWI necessitates immediate blood glucose level assessment.
- Prompt treatment of hypoglycemia is essential for the reversibility of these MRI findings.
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