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A case of hypoglycemic brain injuries with cortical laminar necrosis.

Lee BW, Jin ES, Hwang HS, Yoo HJ, Jeong JH - J. Korean Med. Sci. (2010)

Bottom Line: We report a case of 68-yr-old male who died from brain injuries following an episode of prolonged hypoglycemia.While exploring controversies surrounding magnetic resonance imaging (MRI) findings indicating the bad prognosis in patients with hypoglycemia-induced brain injuries, we here discuss interesting diffusion-MRI of hypoglycemic brain injuries and their prognostic importance focusing on laminar necrosis of the cerebral cortex.

View Article: PubMed Central - PubMed

Affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Hallym University, Seoul, Korea.

ABSTRACT
We report a case of 68-yr-old male who died from brain injuries following an episode of prolonged hypoglycemia. While exploring controversies surrounding magnetic resonance imaging (MRI) findings indicating the bad prognosis in patients with hypoglycemia-induced brain injuries, we here discuss interesting diffusion-MRI of hypoglycemic brain injuries and their prognostic importance focusing on laminar necrosis of the cerebral cortex.

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Related in: MedlinePlus

Angiography and single photon emission computed tomography (SPECT). (A) MR angiography of the brain and neck showed no abnormalities. (B) The SPECT with 99mTc-HMPAO showed focal hypoperfusion in the left temporal lobe.
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Figure 2: Angiography and single photon emission computed tomography (SPECT). (A) MR angiography of the brain and neck showed no abnormalities. (B) The SPECT with 99mTc-HMPAO showed focal hypoperfusion in the left temporal lobe.

Mentions: Neuroimaging with a 1.5 T MR scanner (Magnetom Vision, Siemens Medical solutions, Erlangen, Germany) on hospital day 2 showed multiple bilateral hyper-intense lesions at the cortex (frontal, temporal, parietal and occipital lobes) with gyral distribution, hippocampus, caudate, globus pallidus and putamen on diffusion-MRI and hypo-intense lesions on apparent diffusion coefficient (ADC) map (Fig. 1). This was prominently seen in the occipital lobe. Low signal intensity at T1-weighted image and high signal intensity at T2 weighted image lesion were seen at the same area (Fig. 1B). These abnormalities were global in appearance and did not conform to vascular distributions; furthermore, they look like a train track. Following MR angiography of the brain and neck showed no abnormalities (Fig. 2A). We performed function neuroimaging single photon emission computed tomography (SPECT) with 99mTc-HMPAO) to look for cerebral perfusion defects on hospital day 8. It showed only focal hypoperfusion areas in the left temporal lobe (Fig. 2B). His electroencephalographic examinations on hospital day 10 showed a moderate diffuse cerebral dysfunction but no definite epileptiform discharge. During the supportive medical management in ICU, there was no event and the patient's mental and neunological changes were not noticed. Follow-up MRI on hospital day 22 showed a reversal of the hyperintensity lesions on diffusion-MRI and the hypointensity lesions on ADC map (Fig. 3A). The T1 and T2-weighted images showed linear high signal intensity selectively along the cerebral cortex in the cortical regions of bilateral hemisphere and the basal ganglia with severe parenchymal loss, characteristic of cerebral cortical laminar necrosis (Fig. 3B). Despite intensive medical treatment in ICU, the patient's neurologic condition failed to improve. The patient died of systemic infection and respiratory failure on day 98. Postmortem examination was not followed.


A case of hypoglycemic brain injuries with cortical laminar necrosis.

Lee BW, Jin ES, Hwang HS, Yoo HJ, Jeong JH - J. Korean Med. Sci. (2010)

Angiography and single photon emission computed tomography (SPECT). (A) MR angiography of the brain and neck showed no abnormalities. (B) The SPECT with 99mTc-HMPAO showed focal hypoperfusion in the left temporal lobe.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2877241&req=5

Figure 2: Angiography and single photon emission computed tomography (SPECT). (A) MR angiography of the brain and neck showed no abnormalities. (B) The SPECT with 99mTc-HMPAO showed focal hypoperfusion in the left temporal lobe.
Mentions: Neuroimaging with a 1.5 T MR scanner (Magnetom Vision, Siemens Medical solutions, Erlangen, Germany) on hospital day 2 showed multiple bilateral hyper-intense lesions at the cortex (frontal, temporal, parietal and occipital lobes) with gyral distribution, hippocampus, caudate, globus pallidus and putamen on diffusion-MRI and hypo-intense lesions on apparent diffusion coefficient (ADC) map (Fig. 1). This was prominently seen in the occipital lobe. Low signal intensity at T1-weighted image and high signal intensity at T2 weighted image lesion were seen at the same area (Fig. 1B). These abnormalities were global in appearance and did not conform to vascular distributions; furthermore, they look like a train track. Following MR angiography of the brain and neck showed no abnormalities (Fig. 2A). We performed function neuroimaging single photon emission computed tomography (SPECT) with 99mTc-HMPAO) to look for cerebral perfusion defects on hospital day 8. It showed only focal hypoperfusion areas in the left temporal lobe (Fig. 2B). His electroencephalographic examinations on hospital day 10 showed a moderate diffuse cerebral dysfunction but no definite epileptiform discharge. During the supportive medical management in ICU, there was no event and the patient's mental and neunological changes were not noticed. Follow-up MRI on hospital day 22 showed a reversal of the hyperintensity lesions on diffusion-MRI and the hypointensity lesions on ADC map (Fig. 3A). The T1 and T2-weighted images showed linear high signal intensity selectively along the cerebral cortex in the cortical regions of bilateral hemisphere and the basal ganglia with severe parenchymal loss, characteristic of cerebral cortical laminar necrosis (Fig. 3B). Despite intensive medical treatment in ICU, the patient's neurologic condition failed to improve. The patient died of systemic infection and respiratory failure on day 98. Postmortem examination was not followed.

Bottom Line: We report a case of 68-yr-old male who died from brain injuries following an episode of prolonged hypoglycemia.While exploring controversies surrounding magnetic resonance imaging (MRI) findings indicating the bad prognosis in patients with hypoglycemia-induced brain injuries, we here discuss interesting diffusion-MRI of hypoglycemic brain injuries and their prognostic importance focusing on laminar necrosis of the cerebral cortex.

View Article: PubMed Central - PubMed

Affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Hallym University, Seoul, Korea.

ABSTRACT
We report a case of 68-yr-old male who died from brain injuries following an episode of prolonged hypoglycemia. While exploring controversies surrounding magnetic resonance imaging (MRI) findings indicating the bad prognosis in patients with hypoglycemia-induced brain injuries, we here discuss interesting diffusion-MRI of hypoglycemic brain injuries and their prognostic importance focusing on laminar necrosis of the cerebral cortex.

Show MeSH
Related in: MedlinePlus