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Adult Hypoglycemia
Miral D. Jhaveri, MD; John H. Rees, MD
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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 decrease 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

                                    1. Bathla G et al: MRI and CT appearances in metabolic encephalopathies due to systemic diseases in adults. Clin Radiol. 68(6):545-54, 2013
                                    2. Cheah YS et al: Metabolic neuroimaging of the brain in diabetes mellitus and hypoglycaemia. Nat Rev Endocrinol. 8(10):588-97, 2012
                                    3. 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
                                    4. Guseva N et al: Successful treatment of persistent hyperinsulinemic hypoglycemia with nifedipine in an adult patient. Endocr Pract. 16(1):107-11, 2010
                                    5. Ma JH et al: MR imaging of hypoglycemic encephalopathy: lesion distribution and prognosis prediction by diffusion-weighted imaging. Neuroradiology. 51(10):641-9, 2009
                                    6. 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
                                    7. 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
                                    8. Gallucci M et al: Reversible focal splenial lesions. Neuroradiology. 49(7):541-4, 2007
                                    9. Mori F et al: Hypoglycemic encephalopathy with extensive lesions in the cerebral white matter. Neuropathology. 26(2):147-52, 2006
                                    10. Yanagawa Y et al: Diffusion-weighted MRI predicts prognosis in severe hypoglycemic encephalopathy. J Clin Neurosci. 13(6):696-9, 2006
                                    11. Jung SL et al: Magnetic resonance imaging and diffusion-weighted imaging changes after hypoglycemic coma. J Neuroimaging. 15(2):193-6, 2005
                                    12. Auer RN: Hypoglycemic brain damage. Metab Brain Dis. 19(3-4):169-75, 2004
                                    13. Chan R et al: Case report: hypoglycemia and diffusion-weighted imaging. J Comput Assist Tomogr. 27(3):420-3, 2003
                                    14. Barkovich AJ et al: Imaging patterns of neonatal hypoglycemia. AJNR Am J Neuroradiol. 19(3):523-8, 1998
                                    15. Fujioka M et al: Specific changes in human brain after hypoglycemic injury. Stroke. 28(3):584-7, 1997
                                    16. Turkington RW: Encephalopathy induced by oral hypoglycemic drugs. Arch Intern Med. 137(8):1082-3, 1977
                                    17. SPENCER AM: Post-hypoglycaemic encephalopathy in Sakel's insulin treatment. J Ment Sci. 94(396):513-54, 1948
                                    Related Anatomy
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                                    Related Differential Diagnoses
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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 decrease 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

                                                                      1. Bathla G et al: MRI and CT appearances in metabolic encephalopathies due to systemic diseases in adults. Clin Radiol. 68(6):545-54, 2013
                                                                      2. Cheah YS et al: Metabolic neuroimaging of the brain in diabetes mellitus and hypoglycaemia. Nat Rev Endocrinol. 8(10):588-97, 2012
                                                                      3. 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
                                                                      4. Guseva N et al: Successful treatment of persistent hyperinsulinemic hypoglycemia with nifedipine in an adult patient. Endocr Pract. 16(1):107-11, 2010
                                                                      5. Ma JH et al: MR imaging of hypoglycemic encephalopathy: lesion distribution and prognosis prediction by diffusion-weighted imaging. Neuroradiology. 51(10):641-9, 2009
                                                                      6. 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
                                                                      7. 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
                                                                      8. Gallucci M et al: Reversible focal splenial lesions. Neuroradiology. 49(7):541-4, 2007
                                                                      9. Mori F et al: Hypoglycemic encephalopathy with extensive lesions in the cerebral white matter. Neuropathology. 26(2):147-52, 2006
                                                                      10. Yanagawa Y et al: Diffusion-weighted MRI predicts prognosis in severe hypoglycemic encephalopathy. J Clin Neurosci. 13(6):696-9, 2006
                                                                      11. Jung SL et al: Magnetic resonance imaging and diffusion-weighted imaging changes after hypoglycemic coma. J Neuroimaging. 15(2):193-6, 2005
                                                                      12. Auer RN: Hypoglycemic brain damage. Metab Brain Dis. 19(3-4):169-75, 2004
                                                                      13. Chan R et al: Case report: hypoglycemia and diffusion-weighted imaging. J Comput Assist Tomogr. 27(3):420-3, 2003
                                                                      14. Barkovich AJ et al: Imaging patterns of neonatal hypoglycemia. AJNR Am J Neuroradiol. 19(3):523-8, 1998
                                                                      15. Fujioka M et al: Specific changes in human brain after hypoglycemic injury. Stroke. 28(3):584-7, 1997
                                                                      16. Turkington RW: Encephalopathy induced by oral hypoglycemic drugs. Arch Intern Med. 137(8):1082-3, 1977
                                                                      17. SPENCER AM: Post-hypoglycaemic encephalopathy in Sakel's insulin treatment. J Ment Sci. 94(396):513-54, 1948