title: Multi-modal brain imaging showing brain damage to the orbitofrontal cortex and left hemisphere, in a case of prolonged hypoglycemia-induced transient hemiplegia followed by persistent encephalopathy.
abstract: A 21-year-old left-handed male patient was admitted with a 19-h history of coma after substantial insulin injection for suicide attempt. Although the patient recovered from coma 3 days after injury, he experienced transient hemiplegia followed by permanent brain damage. Electroencephalogram (EEG), brain magnetic resonance imaging (MRI), and brain single-photon emission computed tomography (SPECT) identified the localization of this dysfunction, but consistency between clinical symptoms and brain images changed depending on the course of treatment. Transient hemiplegia corresponded to abnormal waveforms on EEG and decreased cerebral blood flow on SPECT, whereas persistent dysfunctions corresponded to abnormal brain regions on MRI and SPECT.
authors.affiliation: Department of Psychiatry, Tokyo Metropolitan Bokuto Hospital, Tokyo, Japan. skoike-tky@umin.ac.jp
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Koike
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Sasaki
mesh_terms: D000328:Adult; D001927:Brain Diseases / Q000150:complications* / Q000473:pathology*; D003128:Coma / Q000139:chemically induced; D004569:Electroencephalography; D007839:Functional Laterality; D006429:Hemiplegia / Q000209:etiology* / Q000473:pathology*; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000150:complications* / Q000473:pathology*; D007004:Hypoglycemic Agents / Q000506:poisoning; D007328:Insulin / Q000506:poisoning; D008279:Magnetic Resonance Imaging; D008297:Male; D017397:Prefrontal Cortex / Q000473:pathology*; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: brain imaging; diabetic coma; electroencephalography; encephalopathy; hypoglycemia