title: Topography of brain damage in metabolic hypoglycaemia is determined by age at which hypoglycaemia occurred.
abstract: OBJECTIVE
  Having previously shown that comorbidity is a major determinant of neurological sequelae in hypoglycaemia, our aim was to describe the neuroimaging patterns of brain damage in different hypoglycaemic situations and to elucidate the factors that determine lesion topography.
  
  
  METHODS
  We reviewed 50 patients (31 females, 19 males) with symptomatic hypoglycaemia (<2.8 mmol/L) occurring between 1 day and 5 years of age (median 4 d) who had undergone magnetic resonance imaging (MRI; at least axial T2-weighted, sagittal T1-weighted, and coronal fluid-attenuated inversion recovery [FLAIR]-weighted imaging). MRI was performed during the follow-up examination at least 1 month after the occurrence of symptomatic hypoglycaemia, i.e. between 1 month and 5 years of age (median 3 mo). Hypoglycaemia resulted from three inborn errors of metabolism: congenital hyperinsulinism (33 patients), fatty acid β-oxidation disorders (13 patients), or glycogen storage disease type I (four patients). We selected the patients with clear MRI abnormalities and analysed their topography according to aetiology and age at occurrence of the lesion.
  
  
  RESULTS
  The topography of the brain lesions depended on age: from the neonatal period to 6 months of age, lesions predominantly involved the posterior white matter; between 6 and 22 months the basal ganglia, and after 22 months the parietotemporal cortex (p=0.04).
  
  
  CONCLUSIONS
  The relationship between brain lesions and age could reflect the maturation sequence of the brain.
authors.affiliation:  Neuropediatrics Department, Necker-Enfants Malades Hospital, AP-HP, Paris.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Gataullina
authors.affiliation:  Centre for Inherited Metabolic Disorders, Necker-Enfants Malades Hospital AP-HP, Université Paris Descartes, Paris.
authors.forename: Pascale DE
authors.initials: P
authors.lastname: Lonlay
authors.affiliation:  Inserm U669, Université Paris Descartes, Université Paris-Sud, Paris.
authors.forename: Georges
authors.initials: G
authors.lastname: Dellatolas
authors.affiliation:  Reference Centre for Inherited Metabolic Disorders, Necker-Enfants Malades Hospital AP-HP, Paris.
authors.forename: Vassili
authors.initials: V
authors.lastname: Valayannapoulos
authors.affiliation:  Paediatric Department, CHU Hôpital Sud, Rennes.
authors.forename: Silvia
authors.initials: S
authors.lastname: Napuri
authors.affiliation:  Paediatric Department, CHU Hôpital Sud, Rennes.
authors.forename: Léna
authors.initials: L
authors.lastname: Damaj
authors.affiliation:  Centre for Inherited Metabolic Disorders, Necker-Enfants Malades Hospital AP-HP, Université Paris Descartes, Paris.
authors.forename: Guy
authors.initials: G
authors.lastname: Touati
authors.affiliation:  Paediatric Department, CHU Hôpital Saint-Jacques, Besançon.
authors.forename: Cecila
authors.initials: C
authors.lastname: Altuzarra
authors.affiliation:  INSERM UMR663, Université Paris Descartes, Paris.
authors.forename: Olivier
authors.initials: O
authors.lastname: Dulac
authors.affiliation:  Radiologic Department, Necker-Enfants Malades Hospital, AP-HP, Université Paris Descartes, Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Boddaert
mesh_terms: D000367:Age Factors; D001921:Brain / Q000378:metabolism / Q000473:pathology*; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000473:pathology*; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D059906:Neuroimaging