[Hypoglycemia]

Area of Science:

• Neurology
• Radiology
• Metabolic Disorders

Background:

• Hypoglycemia can induce acute hemiplegia, a neurological deficit.
• Diffusion-weighted MRI in hypoglycemic hemiplegia commonly shows internal capsule lesions, resembling acute ischemic stroke.
• Hypoglycemic brain damage may initiate in white matter tracts and extend to gray matter.

Purpose of the Study:

• To review MRI findings in hypoglycemic hemiplegia.
• To discuss the potential progression of hypoglycemic brain damage.
• To highlight the unclear mechanisms behind focal neurological deficits in metabolic disorders.

Main Methods:

• Literature review of MRI findings in hypoglycemia.
• Analysis of reported cases of hypoglycemic hemiplegia.
• Discussion of current understanding of hypoglycemic brain injury patterns.

Main Results:

• The most frequent MRI finding is a hyperintense internal capsule lesion on diffusion-weighted imaging.
• Other reported MRI findings include lesions in the cerebral cortex, basal ganglia, white matter, and corpus callosum.
• Recent evidence suggests damage begins in large white matter tracts and disseminates throughout the brain.

Conclusions:

• Hypoglycemic hemiplegia presents with specific MRI patterns, often mimicking stroke.
• The spread of hypoglycemic brain damage from white matter to gray matter is increasingly recognized.
• The precise mechanisms causing focal neurological deficits in generalized metabolic brain disorders like hypoglycemia require further investigation.