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Updated: Dec 25, 2025
A Multimodal Imaging- and Stimulation-based Method of Evaluating Connectivity-related Brain Excitability in Patients with Epilepsy
Published on: November 13, 2016
"Negative T2 shine through" in patients with hyperglycemia and seizures: a frequently overlooked MRI pattern
Horst Urbach1, Benjamin Berger2, Laszlo Solymosi3
1Department of Neuroradiology, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany. horst.urbach@uniklinik-freiburg.de.
Abstract:
Epileptic seizures associated with hyperglycemia have a rare but characteristic MR imaging pattern which however is frequently missed. It consists of a T2 hypointensity and an apparent diffusion coefficient (ADC) decrease of the white matter underlying the epileptic cortex; the cortex itself may be DWI hyperintense and show a blood-brain barrier disruption. Prompt diagnosis is relevant since treatment of the hyperglycemic state rather than treatment with anti-epileptic drugs frequently interrupts the seizures. Subcortical T2 hypointensity and ADC decrease may be completely reversible.
Insights
Hyperglycemia-associated epileptic seizures show a distinct MRI pattern, often missed, involving white matter changes. Prompt diagnosis and management of high blood sugar, not anti-epileptic drugs, can resolve seizures and imaging findings.
Area of Science:
- Neurology
- Radiology
- Endocrinology
Background:
- Epileptic seizures can occur secondary to hyperglycemia.
- The characteristic magnetic resonance (MR) imaging findings are often overlooked.
- Understanding these imaging patterns is crucial for timely diagnosis and treatment.
Observation:
- A specific MR imaging pattern is associated with hyperglycemia-induced seizures.
- This pattern includes T2 hypointensity and decreased apparent diffusion coefficient (ADC) in the white matter beneath the affected cortex.
- The cerebral cortex itself may exhibit diffusion-weighted imaging (DWI) hyperintensity and blood-brain barrier disruption.
Findings:
- The described MR imaging findings are characteristic of seizures linked to hyperglycemia.
- These include white matter T2 hypointensity and reduced ADC values.
- Cortical changes like DWI hyperintensity and blood-brain barrier disruption can also be present.
Implications:
- Prompt identification of this MR imaging pattern is critical for effective patient management.
- Treatment focused on correcting the hyperglycemic state is often more effective than anti-epileptic drugs for seizure control.
- The observed subcortical T2 hypointensity and ADC decrease are potentially reversible with appropriate management.
