A case of hypoglycemic brain injuries with cortical laminar necrosis

Abstract

We report a case of 68-yr-old male who died from brain injuries following an episode of prolonged hypoglycemia. While exploring controversies surrounding magnetic resonance imaging (MRI) findings indicating the bad prognosis in patients with hypoglycemia-induced brain injuries, we here discuss interesting diffusion-MRI of hypoglycemic brain injuries and their prognostic importance focusing on laminar necrosis of the cerebral cortex.

Keywords: Brain Injuries; Cerebral Cortical Necrosis; Diabetes; Diffusion Magnetic Resonance Imaging; Hypoglycemia; Prognosis.

Fig. 1

The initial magnetic resonance imaging. (A) Diffusion-Weighted MRI of the brain showed multiple bilateral hyperintense signals along the cortical and subcortical regions (frontal, temporal, parietal, and occipital lobes), hippocampus, caudate, globus pallidus, and putament and ADC (afferent diffusion coefficient) map showed low signal at the same area. (B) Low signal intensity lesion at T1-weighted image and High signal intensity lesion at T2 weighted image were seen at same area (Fig. 1B).

Fig. 2

Angiography and single photon emission computed tomography (SPECT). (A) MR angiography of the brain and neck showed no abnormalities. (B) The SPECT with 99mTc-HMPAO showed focal hypoperfusion in the left temporal lobe.

Fig. 3

The follow-up magnetic resonance imaging. (A) Follow-up images on the 20th day show revisal of the hyperintensity lesions on diffusion-MRI and hypointensity lesion on ADC map curvilinear. (B) The T1 and T2-weighted image showed linear high signal intensity selectively along the cortical regions of bilateral hemisphere and basal ganglia.