Hypoglycemia-induced cerebellar dysfunction and quantitative positron emission tomography study

Kim, D.E.; Park, S.H.; Kim, S.K.; Nam, Hyunwoo; Lee, Y.S.; Chung, Joosang; Roh, Jae Kyu

doi:10.1212/wnl.55.3.418

Cited by 17 publications

(18 citation statements)

References 33 publications

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“…It is generally assumed that the cerebellum is efficient in using glucose to help protect it from the effects of hypoglycemia. One small study contradicts this assumption (41). The cerebellum is involved in cognition, in particular with executive function (42).…”

Section: Discussionmentioning

confidence: 99%

Effects of Type 1 Diabetes on Gray Matter Density as Measured by Voxel-Based Morphometry

et al. 2006

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The effects of type 1 diabetes and key metabolic variables on brain structure are not well understood. Sensitive methods of assessing brain structure, such as voxel-based morphometry (VBM), have not previously been used to investigate central nervous system changes in a diabetic population. Using VBM, we compared type 1 diabetic patients aged 25-40 years with disease duration of 15-25 years and minimal diabetes complications with an agematched, nondiabetic control group. We investigated whether lower than expected gray matter densities were present, and if so, whether they were associated with glycemic control and history of severe hypoglycemic events. In comparison with control subjects, diabetic patients showed lower density of gray matter in several brain regions. Moreover, in the patient group, higher HbA 1c levels and severe hypoglycemic events were associated with lower density of gray matter in brain regions responsible for language processing and memory. Our study represents the first comprehensive study of gray matter density changes in type 1 diabetes and suggests that persistent hyperglycemia and acute severe hypoglycemia have an impact on brain structure. Diabetes 55:326 -333, 2006

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Section: Discussionmentioning

confidence: 99%

Effects of Type 1 Diabetes on Gray Matter Density as Measured by Voxel-Based Morphometry

et al. 2006

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“…The only other patient in the literature with normal MRI findings in the setting of hypoglycemia-induced cerebellar dysfunction had normalization of her ataxia within 12 hours of onset. 3 It appears that the neuronal damage in our patient was severe enough to cause prolonged ataxia, however, the damage was reversible as evidenced by the normalization of his ataxia. A question that remains unanswered is whether the relatively normal MRI findings in the setting of hypoglycemia-induced cerebellar dysfunction predict complete recovery as occurred in our patient.…”

Section: Discussionmentioning

confidence: 58%

“…6 The cerebellum is normally protected from hypoglycemia, and several studies in rat and in man have shown differences in glucose metabolism in the cerebellum compared to the cerebrum, providing a physiologic explanation for such protection. 3,8,9 Few other cases have been reported on hypoglycemiainduced cerebellar dysfunction. In those cases, myelinolysis appears to be associated with continued neurologic dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…Kim et al report on a 52-year-old female diabetic who presented with hypoglycemia and was found to have transient cerebellar ataxia that resolved after 12 hours. 3 Workup was otherwise unrevealing including a normal brain MRI. Using insulin and glucose administration along with PET scan evaluation of the brain, this patient was then studied to compare the glucose uptake and metabolism kinetics of her cerebrum and cerebellum compared to that of normal controls.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 This phenomenon is thought to be because of abnormal glucose metabolism in the cerebellum. 3 In this paper, we report the case of a 51-year-old male with diabetes and polysubstance abuse who experienced prolonged but reversible cerebellar ataxia after a severe hypoglycemic episode. His case highlights a seldom-reported cause of ataxia and, in addition to providing an opportunity to review the differential diagnosis of ataxia, serves as a reminder that a history of severe hypoglycemia should be assessed in patients presenting with these findings.…”

Section: Introductionmentioning

confidence: 99%

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Prolonged Cerebellar Ataxia: An Unusual Complication of Hypoglycemia

Berz

Orlander

2007

J GEN INTERN MED

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A 51-year-old male with a history of insulin-dependent diabetes and polysubstance abuse presented after overdose on insulin. Soon after resuscitation, he displayed a severe ataxia in all 4 limbs and was unable to walk; all of which persisted for at least 5 days. Laboratory testing was unrevealing, including relatively normal brain magnetic resonance imaging. He had recovered full neurologic function 3 months after the event. This report describes a case of reversible cerebellar ataxia as a rare complication of severe hypoglycemia that may occur in patients with abnormal cerebellar glucose metabolism. Thus, this phenomenon should be included in the differential diagnosis of patients with a history of hypoglycemia who present with ataxia. In this context, the differential diagnosis of cerebellar ataxia is discussed, as is the proposed mechanism for hypoglycemia-induced cerebellar dysfunction.KEY WORDS: hypoglycemia: ataxia: diabetes mellitus.

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Endocrine Disorders

Manto

2021

Handbook of the Cerebellum and Cerebellar Disorders

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Cerebellum is vulnerable to hormonal disturbances. The main endocrine disorders associated with cerebellar ataxia are thyroid diseases. Both hypothyroidism and hyperthyroidism can induce cerebellar symptoms in children and in adults. In most instances, cerebellar deficits may be reversible with hormonal replacement. Patients with impaired parathyroid hormone signaling may also exhibit cerebellar ataxia, including hypoparathyroidism, pseudohypoparathyroidism, and hyperparathyroidism. Diabetes (diabetes mellitus or diabetes insipidus) may also be combined with cerebellar deficits, sometimes in a context of a complex metabolic inherited disorder. There may be no direct causal association between the endocrine disturbance and cerebellar deficits in this case. The workup of cerebellar ataxia of undetermined cause should include detailed hormonal investigations. In particular, thyrotropin hormone (TSH) and free T4 levels should be determined in all ataxic patients, followed by additional hormonal investigations if necessary.

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Hypoglycemia-induced cerebellar dysfunction and quantitative positron emission tomography study

Abstract: In a case of episodic bilateral cerebellar dysfunction caused by hypoglycemia, quantitative dynamic PET study demonstrated decreased glucose uptake-to-utilization ratio and increased leak of glucose in the cerebellum. The cerebellum is not invariably resistant to hypoglycemia.

Cited by 17 publications

References 33 publications

Effects of Type 1 Diabetes on Gray Matter Density as Measured by Voxel-Based Morphometry

Effects of Type 1 Diabetes on Gray Matter Density as Measured by Voxel-Based Morphometry

Prolonged Cerebellar Ataxia: An Unusual Complication of Hypoglycemia

Endocrine Disorders

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