MR imaging of hypoglycemic encephalopathy: lesion distribution and prognosis prediction by diffusion-weighted imaging.
BACKGROUND
The aim of this study was to evaluate the patterns of hypoglycemic encephalopathy on diffusion-weighted imaging (DWI) and the relationship between the imaging patterns and clinical outcomes.


METHODS
This retrospective study included 17 consecutive patients that had hypoglycemic encephalopathy with DWI abnormalities. The topographic distributions of the DWI abnormalities of the cortex, deep gray matter, and white matter structures were assessed. In addition, possible correlation between the patterns of brain injury on DWI and clinical outcomes was investigated.


RESULTS
There were three patterns of DWI abnormalities: involvement of both gray and white matter (n = 8), selective involvement of gray matter (n = 4), and selective involvement of white matter (n = 5). There was no significant difference in the initial blood glucose levels among patients for each of the imaging patterns. Most patients (16/17) had bilateral symmetrical abnormalities. Among patients with bilateral symmetrical gray and/or white matter injuries, one had moderate to severe disability and 14 remained in a persistent vegetative state. The two patients with a focal unilateral white matter abnormality and a localized splenial abnormality recovered without neurological deficits.


CONCLUSIONS
The results of this study showed that white matter was more sensitive to hypoglycemia than previously thought and there was no specific association between the patterns of injury and clinical outcomes whether the cerebral cortex, deep gray matter, and/or white matter were affected. Diffuse and extensive injury observed on the DWI predicts a poor neurologic outcome in patients with hypoglycemic injuries.
Ma
Jeong-Hyun
JH
Department of Radiology, College of Medicine, The Catholic University of Korea, 65-1 Geumo-dong, Uijongbu, Kyunggi-do 480-130, South Korea.
Kim
Young-Joo
YJ
Yoo
Won-Jong
WJ
Ihn
Yon-Kwon
YK
Kim
Jee-Young
JY
Song
Ha-Hun
HH
Kim
Bum-Soo
BS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose; D001921:Brain / Q000473:pathology*; D001927:Brain Diseases / Q000175:diagnosis* / Q000473:pathology* / Q000628:therapy; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis* / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000473:pathology; D036421:Nerve Fibers, Unmyelinated / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
D001786:Blood Glucose