Early Diffusion MR Imaging Findings and Short-Term Outcome in Comatose Patients with Hypoglycemia

Article Figures & Data

Download figure
Open in new tab
Download powerpoint
Fig 1.
Two different DWI lesion patterns in patients with hypoglycemic coma are indicative of 2 different outcomes. When focal lesions involving the posterior limb of the internal capsule (eg, patient 4, unilateral lesion, A; patient 9, bilateral lesions, B) were seen, outcomes were good. C and D, However when diffuse lesions involving bilateral hemispheric white matter including the internal capsule, corona radiata, and centrum semiovale (eg, patient 19), were seen, outcomes were poor.
Download figure
Open in new tab
Download powerpoint
Fig 2.
Example of a hypoglycemic lesion in the internal capsule depicted by MR imaging (patient 4). DWI (A) reveals a hyperintensity lesion with decreased ADC (B). No lesion is seen in other MR imaging sequences such as FLAIR (C) and T2-weighted (D) and T1-weighted (E) sequences. F, The DWI lesion disappeared completely next day.
Download figure
Open in new tab
Download powerpoint
Fig 3.
Follow-up images of hemispheric white matter and basal ganglia lesions on DWI (A, B, E, F, I, J) and FLAIR (C, D, G, H, K, L) (patient 21). The white matter lesions on arrival (A−D) did not disappear by day 2 (E−H) or by 1 week (I−L) after admission. The basal ganglia lesions became more conspicuous by day 2 (E−H) and became slightly less visible after 1 week (I−L).

Table 1:

Clinical characteristics of comatose patients with hypoglycemia with focal DWI lesions

No./Age (yr)/Sex	Blood Glucose Level (mg/dL)	DWI Pattern on Arrival	DWI Pattern on Day 2	Associated Focal Sign	Outcome
1/63/M	12	Left internal capsule, both cerebral peduncles	No abnormality		Complete recovery within 1 day
2/76/F	24	Bilateral internal capsule	No abnormality		Complete recovery within 1 day
3/83/F	32	Right internal capsule, splenium of the corpus callosum	No abnormality	Left hemiparesis	Complete recovery within 1 day
4/66/M	30	Left internal capsule	No abnormality	Right hemiparesis	Complete recovery within 1 day
5/56/F	32	Left internal capsule	No abnormality	Right hemiparesis	Complete recovery within 1 day
6/73/M	18	Bilateral internal capsule	No abnormality		Complete recovery within 1 day
7/80/M	16	Bilateral internal capsule	No abnormality		Complete recovery within 1 day
8/90/F	29	Left internal capsule	No abnormality		Complete recovery within 1 day
9/67/M	42	Bilateral internal capsule	No abnormality		Complete recovery within 1 day
10/91/F	22	Right internal capsule	No abnormality	Left hemiparesis	Complete recovery within 1 day
11/83/F	47	Bilateral internal capsule	No abnormality		Complete recovery within 1 day
12/81/M	42	Bilateral internal capsule	No abnormality		Complete recovery within 1 day
13/81/F	41	Bilateral internal capsule	No abnormality		Complete recovery within 1 day

Table 2:

Clinical characteristics of comatose patients with hypoglycemic and diffuse DWI lesions

No./Age (yr)/Sex	Blood Glucose Levels (mg/dL)	DWI Lesion Distribution on Arrival^a	DWI Lesions the Next Day	1-Week Outcome
14/87/F	45	Bilateral hemispheric white matter	No change	Died in 5 days
15/79/F	25	Bilateral hemispheric white matter	No change	Vegetative
16/72/M	64	Bilateral hemispheric white matter, bilateral basal ganglia	No change	Vegetative
17/85/F	40	Bilateral hemispheric white matter, splenium of the corpus callosum, bilateral basal ganglia, bilateral occipital cortices	No change	Vegetative
18/61/M	55	Bilateral hemispheric white matter, bilateral basal ganglia, bilateral occipital cortices	No change	Vegetative
19/83/F	35	Bilateral hemispheric white matter	No change	Disoriented
20/85/M	23	Bilateral hemispheric white matter	No change	Disoriented
21/93/F	10	Bilateral hemispheric white matter, left basal ganglia	No change	Vegetative
22/91/F	17	Bilateral hemispheric white matter	No change	Died in 4 days
23/74/F	36	Bilateral hemispheric white matter	No change	Disoriented