April 2, 2015
A 45-year-old man with diabetes mellitus and hypertension presented with seizures, now in coma.
Hypoglycemic Encephalopathy
- Hypoglycemic encephalopathy (HE) is defined as coma/stupor and blood glucose levels < 50 mg/dl on admission, persistence of coma/stupor for ≥ 24 hours despite normalization of blood glucose levels, and exclusion of any other cause of coma/stupor.
- Clinical Presentation: Change in mental status, seizures, coma
- Key Diagnostic Features:Findings include diffusion restriction involving the splenium of the corpus callosum (reversible focal splenial lesion). Occasionally, a more diffuse process, such as in the current case, with diffusion restriction involving the cortical gray matter and the deep gray matter, involving especially the basal ganglia, can be seen. Involvement of the hippocampii may be an associated finding.
- DDx:
- Hypoxic-ischemic encephalopathy
- Creutzfeld-Jakob disease
- Heat stroke
- Other toxic-metabolic causes such as hyperammonemic encephalopathy
- Rx: Intravenous glucose and supportive treatment
