Answer for BIR CoW 24 July 2022
Hypoglycemic encephalopathy
Findings
T2/FLAIR hyperintensities noted involving bilateral hippocampus and medial temporal lobe showing restricted diffusion with low ADC values IMPRESSION : Features consistent with Hypoglycemic encephalopathy
Discussion
Hypoglycemia is the sudden decrease in serum glucose level <50 mg/dL, and the organ systems that manifest the signs and symptoms are the central and autonomic nervous system. Diverse neurologic manifestations of hypoglycemia have been reported frequently. These neurologic symptoms range from focal neurologic deficits to permanent dysfunction or death Neuropathologic studies have demonstrated that the cerebral cortex, hippocampus, and Basal Ganglia are commonly affected sites in severe hypoglycemia; however, the cerebellum and brain stem are usually spared Hypoglycemic encephalopathy is a metabolic encephalopathy. Clinical risk is mixed with acute cerebrovascular disease, so it is critical to identify and make the correct diagnosis of the disease as early as possible. In addition to blood-related indicators and medical histories, magnetic resonance imaging (MRI), especially diffusion-weighted imaging (DWI), can be valuable to the diagnosis of hypoglycemic encephalopathy There are characteristic changes affecting the posterior limb of the internal capsule, cerebral cortex (in particular parieto-occipital and insula), hippocampus and basal ganglia . These are typically bilateral. The cerebellum brainstem and thalami are usually spared in adults but they are also involved in neonates . The splenium of the corpus callosum can also be affected, producing the so-called boomerang sign.
Top Differential Diagnosis for bilateral hippocampal and parieto -occipital hyperintensities 1. Herpes encephalitis 2. Autoimmune encephalitis
References:
Schmidt P, Böttcher J, Ragoschke-Schumm A, Mentzel HJ, Wolf G, Müller UA, Kaiser WA, Mayer TE, Saemann A. Diffusion-weighted imaging of Hyperacute cerebral hypoglycemia. Am J Neuroradiology Hasegawa Y, Formato JE, Latour LL, Gutierrez JA, Liu KF, Garcia JH, Sotak CH, Fisher M. Severe transient hypoglycemia causes reversible change in the apparent diffusion coefficient of water
Findings
T2/FLAIR hyperintensities noted involving bilateral hippocampus and medial temporal lobe showing restricted diffusion with low ADC values IMPRESSION : Features consistent with Hypoglycemic encephalopathy
Discussion
Hypoglycemia is the sudden decrease in serum glucose level <50 mg/dL, and the organ systems that manifest the signs and symptoms are the central and autonomic nervous system. Diverse neurologic manifestations of hypoglycemia have been reported frequently. These neurologic symptoms range from focal neurologic deficits to permanent dysfunction or death Neuropathologic studies have demonstrated that the cerebral cortex, hippocampus, and Basal Ganglia are commonly affected sites in severe hypoglycemia; however, the cerebellum and brain stem are usually spared Hypoglycemic encephalopathy is a metabolic encephalopathy. Clinical risk is mixed with acute cerebrovascular disease, so it is critical to identify and make the correct diagnosis of the disease as early as possible. In addition to blood-related indicators and medical histories, magnetic resonance imaging (MRI), especially diffusion-weighted imaging (DWI), can be valuable to the diagnosis of hypoglycemic encephalopathy There are characteristic changes affecting the posterior limb of the internal capsule, cerebral cortex (in particular parieto-occipital and insula), hippocampus and basal ganglia . These are typically bilateral. The cerebellum brainstem and thalami are usually spared in adults but they are also involved in neonates . The splenium of the corpus callosum can also be affected, producing the so-called boomerang sign.
Top Differential Diagnosis for bilateral hippocampal and parieto -occipital hyperintensities 1. Herpes encephalitis 2. Autoimmune encephalitis
References:
Schmidt P, Böttcher J, Ragoschke-Schumm A, Mentzel HJ, Wolf G, Müller UA, Kaiser WA, Mayer TE, Saemann A. Diffusion-weighted imaging of Hyperacute cerebral hypoglycemia. Am J Neuroradiology Hasegawa Y, Formato JE, Latour LL, Gutierrez JA, Liu KF, Garcia JH, Sotak CH, Fisher M. Severe transient hypoglycemia causes reversible change in the apparent diffusion coefficient of water
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!