title: MR imaging of hypoglycemic encephalopathy: lesion distribution and prognosis prediction by diffusion-weighted imaging.
abstract: 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.
authors.affiliation: Department of Radiology, College of Medicine, The Catholic University of Korea, 65-1 Geumo-dong, Uijongbu, Kyunggi-do 480-130, South Korea.
authors.forename: Jeong-Hyun
authors.initials: JH
authors.lastname: Ma
authors.forename: Young-Joo
authors.initials: YJ
authors.lastname: Kim
authors.forename: Won-Jong
authors.initials: WJ
authors.lastname: Yoo
authors.forename: Yon-Kwon
authors.initials: YK
authors.lastname: Ihn
authors.forename: Jee-Young
authors.initials: JY
authors.lastname: Kim
authors.forename: Ha-Hun
authors.initials: HH
authors.lastname: Song
authors.forename: Bum-Soo
authors.initials: BS
authors.lastname: Kim
mesh_terms: 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
chemical_list: D001786:Blood Glucose