Bilateral middle cerebellar peduncle compromise due to hypoglycemic encephalopathy: A case report and literature review

Abstract

Hypoglycemic encephalopathy constitutes a critical presentation of severely diminished glucose levels. We present the case of a 53-year-old male patient with a history of diabetes mellitus with hypoglycemic encephalopathy and MRI findings of bilateral middle cerebellar peduncle lesions. Common findings of hypoglycemic encephalopathy described in the literature consist of bilateral compromise of the cerebral cortex, basal ganglia, hippocampus, and long tracts of white matter. The cerebellum and brainstem are usually not affected. This is the ninth report of cerebellar peduncle compromise with hypoglycemia. As increasing evidence regarding prognosis estimation of lesion distribution arises, we consider it important to report the different cases of rare patterns of compromise.

Keywords: Diagnosis; Hypoglycemic encephalopathy; Middle cerebellar peduncle; Prognosis.

Fig. 1

MRI images showed symmetrical areas of high signal intensity at the level of the middle cerebellar peduncles on T2WI in both axial (A) and coronal (B) projections, which have the same distribution in FLAIR (C) and maintain a high signal in diffusion-weighted images (D).