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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
TERMINOLOGY
Abbreviations
- Adult hypoglycemic encephalopathy (AHE)
Synonyms
- Hypoglycemic brain injury
- Diabetic coma (nonspecific; term may include AHE)
Definitions
- Imbalance between glucose supply & utilization → brain injury
- Hypoglycemia: Sudden ↓ in serum glucose level < 50 mg/dL
IMAGING
General Features
CT Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Image Interpretation Pearls
Selected References
- Arrabyru PR et al: Magnetic resonance imaging changes in a 69-year old man with hypoglycemia induced brain injury: case report and literature review. Pan Afr Med J. 32:131, 2019
- de Oliveira AM et al: Imaging patterns of toxic and metabolic brain disorders. Radiographics. 39(6):1672-95, 2019
- Bathla G et al: MRI and CT appearances in metabolic encephalopathies due to systemic diseases in adults. Clin Radiol. 68(6):545-54, 2013
- Cheah YS et al: Metabolic neuroimaging of the brain in diabetes mellitus and hypoglycaemia. Nat Rev Endocrinol. 8(10):588-97, 2012
- Johkura K et al: Early diffusion MR imaging findings and short-term outcome in comatose patients with hypoglycemia. AJNR Am J Neuroradiol. 33(5):904-9, 2012
- Guseva N et al: Successful treatment of persistent hyperinsulinemic hypoglycemia with nifedipine in an adult patient. Endocr Pract. 16(1):107-11, 2010
- Ma JH et al: MR imaging of hypoglycemic encephalopathy: lesion distribution and prognosis prediction by diffusion-weighted imaging. Neuroradiology. 51(10):641-9, 2009
- Catton JA et al: Diffuse nesidioblastosis causing hyperinsulinemic hypoglycemia: the importance of pancreatic sampling on EUS. Gastrointest Endosc. 68(3):571-2; discussion 572, 2008
- Kellogg TA et al: Postgastric bypass hyperinsulinemic hypoglycemia syndrome: characterization and response to a modified diet. Surg Obes Relat Dis. 4(4):492-9, 2008
- Gallucci M et al: Reversible focal splenial lesions. Neuroradiology. 49(7):541-4, 2007
- Mori F et al: Hypoglycemic encephalopathy with extensive lesions in the cerebral white matter. Neuropathology. 26(2):147-52, 2006
- Yanagawa Y et al: Diffusion-weighted MRI predicts prognosis in severe hypoglycemic encephalopathy. J Clin Neurosci. 13(6):696-9, 2006
- Jung SL et al: Magnetic resonance imaging and diffusion-weighted imaging changes after hypoglycemic coma. J Neuroimaging. 15(2):193-6, 2005
- Auer RN: Hypoglycemic brain damage. Metab Brain Dis. 19(3-4):169-75, 2004
- Chan R et al: Case report: hypoglycemia and diffusion-weighted imaging. J Comput Assist Tomogr. 27(3):420-3, 2003
- Barkovich AJ et al: Imaging patterns of neonatal hypoglycemia. AJNR Am J Neuroradiol. 19(3):523-8, 1998
- Fujioka M et al: Specific changes in human brain after hypoglycemic injury. Stroke. 28(3):584-7, 1997
- Turkington RW: Encephalopathy induced by oral hypoglycemic drugs. Arch Intern Med. 137(8):1082-3, 1977
- SPENCER AM: Post-hypoglycaemic encephalopathy in Sakel's insulin treatment. J Ment Sci. 94(396):513-54, 1948
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
TERMINOLOGY
Abbreviations
- Adult hypoglycemic encephalopathy (AHE)
Synonyms
- Hypoglycemic brain injury
- Diabetic coma (nonspecific; term may include AHE)
Definitions
- Imbalance between glucose supply & utilization → brain injury
- Hypoglycemia: Sudden ↓ in serum glucose level < 50 mg/dL
IMAGING
General Features
CT Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Image Interpretation Pearls
Selected References
- Arrabyru PR et al: Magnetic resonance imaging changes in a 69-year old man with hypoglycemia induced brain injury: case report and literature review. Pan Afr Med J. 32:131, 2019
- de Oliveira AM et al: Imaging patterns of toxic and metabolic brain disorders. Radiographics. 39(6):1672-95, 2019
- Bathla G et al: MRI and CT appearances in metabolic encephalopathies due to systemic diseases in adults. Clin Radiol. 68(6):545-54, 2013
- Cheah YS et al: Metabolic neuroimaging of the brain in diabetes mellitus and hypoglycaemia. Nat Rev Endocrinol. 8(10):588-97, 2012
- Johkura K et al: Early diffusion MR imaging findings and short-term outcome in comatose patients with hypoglycemia. AJNR Am J Neuroradiol. 33(5):904-9, 2012
- Guseva N et al: Successful treatment of persistent hyperinsulinemic hypoglycemia with nifedipine in an adult patient. Endocr Pract. 16(1):107-11, 2010
- Ma JH et al: MR imaging of hypoglycemic encephalopathy: lesion distribution and prognosis prediction by diffusion-weighted imaging. Neuroradiology. 51(10):641-9, 2009
- Catton JA et al: Diffuse nesidioblastosis causing hyperinsulinemic hypoglycemia: the importance of pancreatic sampling on EUS. Gastrointest Endosc. 68(3):571-2; discussion 572, 2008
- Kellogg TA et al: Postgastric bypass hyperinsulinemic hypoglycemia syndrome: characterization and response to a modified diet. Surg Obes Relat Dis. 4(4):492-9, 2008
- Gallucci M et al: Reversible focal splenial lesions. Neuroradiology. 49(7):541-4, 2007
- Mori F et al: Hypoglycemic encephalopathy with extensive lesions in the cerebral white matter. Neuropathology. 26(2):147-52, 2006
- Yanagawa Y et al: Diffusion-weighted MRI predicts prognosis in severe hypoglycemic encephalopathy. J Clin Neurosci. 13(6):696-9, 2006
- Jung SL et al: Magnetic resonance imaging and diffusion-weighted imaging changes after hypoglycemic coma. J Neuroimaging. 15(2):193-6, 2005
- Auer RN: Hypoglycemic brain damage. Metab Brain Dis. 19(3-4):169-75, 2004
- Chan R et al: Case report: hypoglycemia and diffusion-weighted imaging. J Comput Assist Tomogr. 27(3):420-3, 2003
- Barkovich AJ et al: Imaging patterns of neonatal hypoglycemia. AJNR Am J Neuroradiol. 19(3):523-8, 1998
- Fujioka M et al: Specific changes in human brain after hypoglycemic injury. Stroke. 28(3):584-7, 1997
- Turkington RW: Encephalopathy induced by oral hypoglycemic drugs. Arch Intern Med. 137(8):1082-3, 1977
- SPENCER AM: Post-hypoglycaemic encephalopathy in Sakel's insulin treatment. J Ment Sci. 94(396):513-54, 1948
