Hypoglycemic encephalopathy

Case contributed by Mohammad A. ElBeialy , 22 Aug 2015
Diagnosis certain
Changed by Bruno Di Muzio, 23 Aug 2015

Updates to Case Attributes

Presentation was changed:
Suicidal attempt by over-dosageoverdosage of insulin. Patient who has psychiatric disorders and unknown to be diabetic been brought to the casualty department comatosed.
Age changed from 45 years. to 45.
Body was changed:

Hypoglycemic brain injury is typically diagnosed in comatosedcomatose adult diabetic men on insulin with brain insult due to insulin over dosageoverdosage. The lesion usually involves the  frontalfrontal, parietal, temporal and ocipitaloccipital cortex and subcortex with relative sparing of the deep white matter. The basal ganglia are involved in severe cases. The thalami are always spared as well as the cerebellum and the brain stem. 

The lack of deep white matter injury, haemorrhagic reperfusion as well as the lack of the thalamic affection are the main differentiating points between hypoglycemic and hypoxic-ischemic brain insult.  

  • -<p><a title="Hypoglycemic brain injury" href="/articles/hypoglycaemic-encephalopathy">Hypoglycemic brain injury</a> is typically diagnosed in comatosed adult diabetic men on insulin with brain insult due to insulin over dosage. The lesion usually involves the  frontal, parietal , temporal and ocipital cortex and subcortex with relative sparing of the deep white matter. The basal ganglia are involved in severe cases. The thalami are always spared as well as the cerebellum and the brain stem. </p><p>The lack of deep white matter injury, haemorrhagic reperfusion as well as the lack of the thalamic affection are the main differentiating points between hypoglycemic and <a title="hypoxic-ischemic brain injury" href="/articles/hypoxic-ischaemic-brain-injury-1">hypoxic-ischemic</a> brain insult.  </p><p> </p>
  • +<p><a href="/articles/hypoglycaemic-encephalopathy">Hypoglycemic brain injury</a> is typically diagnosed in comatose adult diabetic men on insulin with brain insult due to insulin overdosage. The lesion usually involves the frontal, parietal, temporal and occipital cortex and subcortex with relative sparing of the deep white matter. The basal ganglia are involved in severe cases. The thalami are always spared as well as the cerebellum and the brain stem. </p><p>The lack of deep white matter injury, haemorrhagic reperfusion as well as the lack of the thalamic affection are the main differentiating points between hypoglycemic and <a href="/articles/hypoxic-ischaemic-brain-injury-1">hypoxic-ischemic</a> brain insult.  </p>

Updates to Study Attributes

Caption was added:
MRI Brain
Findings was changed:

Bilateral cerebral cortical and subcortical patchy and confluent lesions with restricted diffusion are seen with hyperintense DWI, low ADC signal &and subtle T2/FLAIR hyperintensity. The amygdalae, the hippocampi as well as the insular cortices are seen involved. The deep grey matter nuclei (basal ganglia) as well as the the thalami and the cerebellum are spared.

A few bilateral cerebral deep white matter lesions with hyperintense T2/FLAIR signal are seen consistent with chronic small vessel disease. 

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Image MRI (T2) ( update )

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Image MRI (T2) ( update )

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Image 3 MRI (FLAIR) ( update )

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