title: Transient interhemispheric disconnection in a case of insulinoma-induced hypoglycemic encephalopathy.
abstract: We report a case of a 22-year-old male who was transferred to our hospital in a comatose state following successive seizures. Low blood glucose had been detected upon his arrival at the previous hospital. He became responsive 12 days after the onset of coma. Upon regaining consciousness he exhibited severe dysarthria and several interhemispheric disconnection signs such as intermanual conflict, left-hand dysgraphia, left hemispatial neglect confined to the right hand, impaired interhemispheric transfer, and unilateral constructional apraxia of the right hand. Brain MRI disclosed T2-weighted and diffusion-weighted hyperintense lesions with reduced apparent diffusion coefficients in the bilateral centrum semiovale, splenium of the corpus callosum, right posterior limb of the internal capsule, and bilateral middle cerebellar peduncles. As the MRI findings vanished, his interhemispheric disconnection signs gradually resolved. Abdominal imaging studies revealed a pancreatic tumor, which was later endocrinologically diagnosed as an insulinoma. This is an extremely rare report of interhemispheric disconnection signs due to hypoglycemic encephalopathy. The lesions in the bilateral centrum semiovale likely contributed to the interhemispheric disconnection signs.
authors.affiliation: Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Japan.
authors.forename: Chikara
authors.initials: C
authors.lastname: Yamashita
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shigeto
authors.forename: Norihisa
authors.initials: N
authors.lastname: Maeda
authors.forename: Minako
authors.initials: M
authors.lastname: Kawaguchi
authors.forename: Mitsue
authors.initials: M
authors.lastname: Uryu
authors.forename: Satoru
authors.initials: S
authors.lastname: Motomura
authors.forename: Jun-ichi
authors.initials: J
authors.lastname: Kira
mesh_terms: D001927:Brain Diseases / Q000150:complications / Q000209:etiology*; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology; D003337:Corpus Callosum / Q000473:pathology*; D007839:Functional Laterality; D006801:Humans; D007003:Hypoglycemia / Q000150:complications / Q000209:etiology*; D007340:Insulinoma / Q000150:complications*; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D010190:Pancreatic Neoplasms / Q000150:complications*; D055815:Young Adult
keywords: Centrum semiovale; Corpus callosum; Diffusion-weighted MRI; Hypoglycemic encephalopathy; Insulinoma; Interhemispheric disconnection; Myelin; Splenium