Answer for BIR CoW 03 Apr 2022
Non Ketotic Hyperglycemia
Findings
T2/ FLAIR hypointensity in subcortical white matter of right occipital region with low ADC values and no gradient blooming.
Discussion
Epidemiology Age-middle-aged to elderly patients with type 2 diabetes mellitus without any significant gender predilection.It has been reported that up to 25% of patients with non ketotic hyperglycemia develop seizures.Interestingly, seizures are comparatively very rare in ketotic hyperglycaemia. Clinical presentation Seizures are seen in the early stages of non-ketotic hyperglycaemia, usually, days before coma manifests . Most commonly the seizures are focal motor seizures, with a temporal lobe focus, however focal seizures with an occipital lobe focus have also been reported. Symptoms usually resolve upon normalisation of glucose levels . Radiographic features CT CT of the brain is often normal throughout the presentation, however, regions of decreased density have been reported MRI MRI of the brain is the modality of choice for assessing possible non-ketotic hyperglycaemic seizures and demonstrates many features at the epileptogenic focus T1: mostly normal T2/FLAIR: subcortical regions of hypointensity DWI: often normal ADC values ASL PERFUSION: relatively increased CBF in the corresponding regions. T1 C+ (Gd): leptomeningeal enhancement has been reported in at least one study Imaging findings gradually resolve after glycaemia correction, however the evolution of mild atrophy in the region of the epileptogenic focus has been reported. This is in stark contrast to classical expected MR findings of which include regions of T2-weighted hyperintensity and high diffusion signal on DWI, without any significant long-term sequelae Treatment and prognosis Management is through normalisation of glucose levels
Findings
T2/ FLAIR hypointensity in subcortical white matter of right occipital region with low ADC values and no gradient blooming.
Discussion
Epidemiology Age-middle-aged to elderly patients with type 2 diabetes mellitus without any significant gender predilection.It has been reported that up to 25% of patients with non ketotic hyperglycemia develop seizures.Interestingly, seizures are comparatively very rare in ketotic hyperglycaemia. Clinical presentation Seizures are seen in the early stages of non-ketotic hyperglycaemia, usually, days before coma manifests . Most commonly the seizures are focal motor seizures, with a temporal lobe focus, however focal seizures with an occipital lobe focus have also been reported. Symptoms usually resolve upon normalisation of glucose levels . Radiographic features CT CT of the brain is often normal throughout the presentation, however, regions of decreased density have been reported MRI MRI of the brain is the modality of choice for assessing possible non-ketotic hyperglycaemic seizures and demonstrates many features at the epileptogenic focus T1: mostly normal T2/FLAIR: subcortical regions of hypointensity DWI: often normal ADC values ASL PERFUSION: relatively increased CBF in the corresponding regions. T1 C+ (Gd): leptomeningeal enhancement has been reported in at least one study Imaging findings gradually resolve after glycaemia correction, however the evolution of mild atrophy in the region of the epileptogenic focus has been reported. This is in stark contrast to classical expected MR findings of which include regions of T2-weighted hyperintensity and high diffusion signal on DWI, without any significant long-term sequelae Treatment and prognosis Management is through normalisation of glucose levels
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!