Diffusion-Weighted Imaging of Hyperacute Cerebral Hypoglycemia

Abstract

BACKGROUND AND PURPOSE:Cerebral hypoglycemia can result in reversible metabolic brain insults and can be associated with impaired diffusion disturbances. Our aim was to evaluate possible changes in DWI of the human brain during hyperacute short-term severe hypoglycemia.

Neuroimaging in Patients with Abnormal Blood Glucose Levels

“…Symptomatic hypoglycemia is believed to affect 2% of diabetic patients annually and is associated with up to 4% of deaths in patients with type 1 diabetes. 6,11,49 Other causes include exogenous administration of insulin, which may be suicidal or accidental, insulin-secreting tumors, sepsis, Addison disease, and hepatic or renal failure. 6,7,11 Hypoglycemic symptoms can be divided into autonomic, which include sweating, trembling, palpitations, and anxiety and neuroglycopenic, which include weakness, confusion, personality changes, seizures, and transient memory loss.…”

“…6,11,49 Other causes include exogenous administration of insulin, which may be suicidal or accidental, insulin-secreting tumors, sepsis, Addison disease, and hepatic or renal failure. 6,7,11 Hypoglycemic symptoms can be divided into autonomic, which include sweating, trembling, palpitations, and anxiety and neuroglycopenic, which include weakness, confusion, personality changes, seizures, and transient memory loss. 6,7,15,50,51 Severe hypoglycemia may present with altered mental state or coma.…”

“…[8][9][10] Similar findings may occur in hypoglycemic patients, who can additionally present with chorea, ataxia, paresis, aphasia, and coma. 8,[11][12][13] Neonates with hypoglycemia may show a constellation of symptoms that are usually nonspecific and include poor feeding, lip smacking, eye rolling, and seizures. 4,14 In emergency settings, it is not uncommon for these symptoms be diagnosed and treated initially as stroke.…”

“…Aspartate is a known neurotoxin and has been shown to cause preferential neuronal necrosis in the cerebral cortex, neostriatum, and hippocampus. 6,11,15,50 Hypoglycemia was initially reported to predominantly involve the cortex, neostriatum, and hippocampus. 6,11,12,54,57 However, many authors have also reported predominant WM involvement, mainly affecting the centrum semiovale, corona radiata, internal capsule, an splenium of the corpus callosum.…”

“…6,11,15,50 Hypoglycemia was initially reported to predominantly involve the cortex, neostriatum, and hippocampus. 6,11,12,54,57 However, many authors have also reported predominant WM involvement, mainly affecting the centrum semiovale, corona radiata, internal capsule, an splenium of the corpus callosum. 7,11,12,53,54,56 In fact, involvement of the WM is now thought to be earlier and more common than gray matter involvement.…”