Diffusion-weighted Imaging of a Patient in a Hypoglycemic Coma- A Case Report -
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A 65-year-old woman with type 2 diabetes mellitus was found in an unresponsive state and she was admitted to our hospital. She was comatose on arrival. The bedside blood glucose level on admission was 15 mg/dl (normal range, 55-110 mg/dl). After emergency infusion with 50% dextrose, the blood glucose level rapidly normalized to 98 mg/dl, but there was no clinical improvement of her consciousness. Three days after admission, diffusion-weighted magnetic resonance imaging of the brain revealed bilateral temporal, occipital and frontal lobes lesions with high signal intensity. The patient`s neurological condition did not change over the next 15 days. She died of pneumonia on the 30th day of hospitalization. DWI may be useful for detecting and making the differential diagnosis of hypoglycemic coma. Further, marked differences in the neuroimaging patterns of patients in a hypoglycemic coma are valuable prognostic predictors. We report here on a case of hypoglycemic coma with a poor outcome.
Abstract
A 65-year-old woman with type 2 diabetes mellitus was found in an unresponsive state and she was admitted to our hospital. She was comatose on arrival. The bedside blood glucose level on admission was 15 mg/dl (normal range, 55-110 mg/dl). After emergency infusion with 50% dextrose, the blood glucose level rapidly normalized to 98 mg/dl, but there was no clinical improvement of her consciousness. Three days after admission, diffusion-weighted magnetic resonance imaging of the brain revealed bilateral temporal, occipital and frontal lobes lesions with high signal intensity. The patient`s neurological condition did not change over the next 15 days. She died of pneumonia on the 30th day of hospitalization. DWI may be useful for detecting and making the differential diagnosis of hypoglycemic coma. Further, marked differences in the neuroimaging patterns of patients in a hypoglycemic coma are valuable prognostic predictors. We report here on a case of hypoglycemic coma with a poor outcome.
참고문헌 (13)
- Auer RN, "Progress review: hypoglycemic brain damage", Stroke, 17, pp.699~708 (1986)
- Boeve BF, "Bilateral temporal lobe MRI changes in uncomplicated hypoglycemic coma", Can J Neurol Sci, 22, pp.56~58 (1995)
- Finelli PF, "Diffusion-weighted MR in hypoglycemic coma", Neurology, 57, pp.933~ (2001)
- Auer RN, "Hypoglycaemia: brain neurochemistry and neuropathology", Baillieres Clin Endocrinol Metab, 7, pp.611~625 (1993)
- Pelligrino D, "Effects of insulin- induced hypoglycemia on intracellular pH and impedance in the cerebral cortex of the rat", Brain Res, 221, pp.129~147 (1981)
- Mori F, "Hypoglycemic encephalopathy with extensive lesions in the cerebral white matter", Neuropathology, 26, pp.147~152 (2006)
- Hasegawa Y, "Severe transient hypoglycemia causes reversible change in the apparent diffusion coefficient of water", Stroke, 27, pp.1648~1656 (1996)
- de Crespigny AJ, "Rapid monitoring of diffusion, DC potential, and blood oxygenation changes during global ischemia. Effects of hypoglycemia, hyperglycemia, and TTX", Stroke, 30, pp.2212~2222 (1999)
- Fujioka M, "Specific changes in human brain after hypoglycemic injury", Stroke, 28, pp.584~587 (1997)
- Lo L, "Diffusion-weighted MR imaging in early diagnosis and prognosis of hypoglycemia", AJNR Am J Neuroradiol, 27, pp.1222~1224 (2006)
- Aoki T, "Reversible hyperintensity lesion on diffusion-weighted MRI in hypoglycemic coma", Neurology, 63, pp.392~393 (2004)
- Albayram S, "Reversible reduction of apparent diffusion coefficient values in bilateral internal capsules in transient hypoglycemia- induced hemiparesis", AJNR Am J Neuroradiol, 27, pp.1760~1762 (2006)
- Terakawa Y, "Reversible diffusion-weighted imaging changes in the splenium of the corpus callosum and internal capsule associated with hypoglycemia -case report-", Neurol Med Chir (Tokyo), 47, pp.486~488 (2007)
