Diffusion MR Imaging of Hypoglycemic Encephalopathy

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Fig 1.
A 63-year-old woman (patient 4) was found unconscious. DWI on admission shows hyperintense lesions in the IC, CR, and CS (A) with reduced ADC values (arrows, B). These lesions are bilateral and symmetric.
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Fig 2.
A 45-year-old man (patient 11) was found in a coma. A, DWI shows bilaterally asymmetric confluent hyperintense lesions in the frontal, parietal, insular, temporal, occipital cortices, and BG. B, On ADC maps, these lesions show low SI, but the WM was spared.
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Fig 3.
A 75-year-old woman (patient 7) was found in a confused mental state. A, Initial DWI on admission shows hyperintense lesions in the IC and CR, with reduced ADC values. B, Follow-up DWI obtained 4 days after symptom improvement shows that the hyperintense lesions have disappeared, with normalization of ADC values.

Table 1:

Lesion distribution on MRI^a

Patient No.	WM				Gray matter						Hippocampus	Bilaterality
Patient No.	CS	CR	IC	CC	FL	PA	TL	OC	IN	BG	Hippocampus	Bilaterality
1	+	+	+	–	–	+	–	–	–	–	–	+
2	+	+	–	–	+	–	–	–	–	–	–	+
3	–	–	–	–	+	+	–	+	–	–	+	+
4	+	+	+	–	+	+	–	–	–	–	–	+
5	+	+	+	–	+	–	–	–	–	–	–	+
6	+	+	+	–	–	–	–	–	–	–	+	–^b
7	+	–	+	–	+	–	–	–	–	–	–	+
8	+	–	–	–	+	–	–	–	–	–	–	+
9	+	+	+	–	–	–	–	–	–	–	–	+
10	+	+	–	–	–	–	–	–	–	–	+	+
11	–	–	–	–	+	+	+	+	+	+	+	+

a + indicates the presence of a lesion at each anatomic location; –, no abnormality at each anatomic location on MR image.
b Unilateral involvement because there was an old infarction at the right MCA territory.

Table 2:

ADC values of lesions for DWI on initial MRI^a

Patient No.	MR Imaging Findings			Follow-Up MR Imaging	Interval between Initial and Follow-Up (Day)
Patient No.	SI on DWI	ADC Value of Lesion (10⁻⁶ mm²/s)	ADC of the Non-Involved Area (10⁻⁶ mm²/s)	Follow-Up MR Imaging	Interval between Initial and Follow-Up (Day)
1	High	542 ± 31.37	946 ± 52.50	Reversible	11
2	High	416 ± 33.69	837 ± 117.90	No
3	High	432 ± 55.79	794 ± 52.50	No
4	High	578 ± 40.93	914 ± 45.04	No
5	High	496 ± 33.31	784 ± 43.93	Reversible	18
6	High	413 ± 26.15	882 ± 95.70	Reversible	19
7	High	458 ± 35.21	786 ± 61.04	Reversible	6
8	High	486 ± 28.62	892 ± 50.33	Reversible	4
9	High	514 ± 32.54	788 ± 81.04	Reversible	8
10	High	354 ± 42.32	759 ± 43.42	No
11	High	248 ± 70.13	833 ± 84.22	No