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. 2010 Mar;31(3):559-64.
doi: 10.3174/ajnr.A1856. Epub 2009 Oct 29.

Diffusion MR imaging of hypoglycemic encephalopathy

E G Kang  1 , S J Jeon, S S Choi, C J Song, I K Yu
Affiliations

Diffusion MR imaging of hypoglycemic encephalopathy

E G Kang et al. AJNR Am J Neuroradiol. 2010 Mar.

Abstract

Background and purpose: MR imaging features of HE have not been fully established. The purpose of this study was to determine the topographic distribution and DWI findings of HE.

Materials and methods: We retrospectively evaluated HE MR imaging (n = 11). The topographic distribution of the lesions was evaluated on routine MR imaging, and DWI SI and ADC values were assessed. The ADC value of involved lesions was compared with the noninvolved subcortical WM area by use of the paired t test.

Results: MR images demonstrated bilateral diffusion-restrictive lesions in the posterior limb of the IC (n = 6), cerebral cortex (n = 8), CR (n = 7), CS (n = 9), hippocampus (n = 4), and BG (n = 1). The mean ADC value of lesions was 448.82 +/- 92.34 x 10(-6) mm(2)/s compared with the mean ADC value of noninvolved lesions (837.72 +/- 62.14 x 10(-6) mm(2)/s); this difference was statistically significant (P < .000). The lesions showed complete resolution on follow-up DWI for 6 patients. Three patients with cortical involvement of > or = 2 lobes showed partial recovery or death, but most of the other patients with WM involvement or cortical involvement in only 1 lobe experienced complete recovery.

Conclusions: The topographic localization of the lesions was the posterior limb of the IC, cerebral cortex, CR, CS, hippocampus, and BG. Most HE lesions probably correspond to areas of reversible cytotoxic edema as seen on DWI, which can predict the prognosis of HE according to the degree of lesion extent.

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Figures

Fig 1.
Fig 1.
A 63-year-old woman (patient 4) was found unconscious. DWI on admission shows hyperintense lesions in the IC, CR, and CS (A) with reduced ADC values (arrows, B). These lesions are bilateral and symmetric.
Fig 2.
Fig 2.
A 45-year-old man (patient 11) was found in a coma. A, DWI shows bilaterally asymmetric confluent hyperintense lesions in the frontal, parietal, insular, temporal, occipital cortices, and BG. B, On ADC maps, these lesions show low SI, but the WM was spared.
Fig 3.
Fig 3.
A 75-year-old woman (patient 7) was found in a confused mental state. A, Initial DWI on admission shows hyperintense lesions in the IC and CR, with reduced ADC values. B, Follow-up DWI obtained 4 days after symptom improvement shows that the hyperintense lesions have disappeared, with normalization of ADC values.
See this image and copyright information in PMC

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