The radiological findings of hypoglycemic encephalopathy: A case report with high b value DWI analysis

Abstract

Rationale: Hypoglycemic encephalopathy is a metabolic encephalopathy. Clinical risk is mixed with acute cerebrovascular disease, so it is critical to identify and make the correct diagnosis of the disease as early as possible.

Patient concerns: Here, we report a case of a 51-year-old male patient with hypoglycemic encephalopathy, who presented confusion and unconsciousness for 1 day.

Diagnoses: In addition to blood-related indicators and medical histories, magnetic resonance imaging (MRI), especially diffusion-weighted imaging (DWI), can be valuable to the diagnosis of hypoglycemic encephalopathy, which showed diffuse high-signal intensity in the cerebral cortex, and also the hippocampus, head of the caudate nucleus, the lentiform nucleus, and corpus callosum.

Interventions: Intravenous glucose injection and drip was performed repeatedly. The blood glucose levels were gradually corrected, and the resulting blood glucose was 6.5 mmol/L.

Outcomes: The prognosis depends on the degree of hypoglycemia, duration, and condition of the organism. Due to the long duration of hypoglycemia, unfortunately, the patient died.

Lessons: It is critical to diagnose hypoglycemic encephalopathy as early as possible. MRI reveals diffuse abnormal intensity in the cortex and basal ganglia region. DWI using high b values provides important information for diagnosis.

Figure 1

Diffusion-weighted imaging (DWI) showed diffuse high signal intensity in the cortex of the bilateral frontal, temporal, parietal, and occipital lobe, and also the hippocampus, head of the caudate nucleus, the lentiform nucleus, and corpus callosum (b value = 1000 s/mm²) (A). Lesions were more clearly shown by higher b values (b value = 2000 s/mm²) (B). Lesions showed the slightly low signal intensity on T1WI (C). Lesions showed the slightly high signal intensity on T2WI (D) and FLAIR (E). No obvious blood vessel stenosis was found on MRA (F). FLAIR = fluid attenuation inversion recovery, MRA = magnetic resonance angiography, MRI = magnetic resonance imaging, T1WI = T1-weighted image, T2WI = T2-weighted image.