Question 2586
{"accessible":true,"alternatives":[{"id":12690,"text":"carbon monoxide poisoning"},{"id":12691,"text":"heroin-induced leukoencephalopathy"},{"id":12692,"text":"hypoglycemic encephalopathy"},{"id":12694,"text":"osmotic demyelination syndrome"},{"id":12693,"text":"Wernicke encephalopathy"}],"archived":false,"correctAlternativeId":12692,"explanation":"\u003cp\u003eOf the provided answers, only hypoglycemic encephalopathy manifests with diffuse bilateral cortical restricted diffusion, depicted on this apparent diffusion coefficient map. The differential includes hypoxic-ischemic encephalopathy, but the sparing of the thalami as well as of the cerebellum (not shown) favored hypoglycemic encephalopathy in this case. This patient was found hypoglycemic on rapid blood testing, and a long-acting insulin pen was found in possession despite not being known to be a diabetic, supporting the diagnosis.\u003c/p\u003e\u003cp\u003eCarbon monoxide poisoning affects the globi pallidi. Heroin-induced leukoencephalopathy affects the cerebral white matter. Wernicke encephalopathy affects the medial thalami, mammillary bodies, and periaqueductal midbrain. Osmotic demyelination syndrome most often affects the pons and occasionally extrapontine structures such as the basal ganglia and cerebral white matter.\u003c/p\u003e","id":2586,"imageUrl":"https://prod-images-static.radiopaedia.org/images/57464263/11._big_gallery.jpeg","imageAttribution":{"kind":"case","rID":98332},"imageAttributionCaseInfo":{"title":"Hypoglycemic encephalopathy","contributor_name":"Derek Smith","contributor_param":"dereks","case_rid":98332,"case_param":"hypoglycaemic-encephalopathy-7"},"firstQuestionPath":"/questions/2591","nextQuestionPath":"/articles/osmotic-demyelination-syndrome/questions/2380","relatedArticles":[{"id":5627,"title":"Wernicke encephalopathy","link":"/articles/wernicke-encephalopathy?lang=us"},{"id":4441,"title":"Heroin-induced leukoencephalopathy","link":"/articles/heroin-induced-leukoencephalopathy?lang=us"},{"id":37277,"title":"Hypoglycemic encephalopathy","link":"/articles/hypoglycaemic-encephalopathy?lang=us"},{"id":14025,"title":"Hypoxic-ischemic encephalopathy (adults and children)","link":"/articles/hypoxic-ischaemic-encephalopathy-adults-and-children?lang=us"}],"alsoUsedIn":[{"id":1397,"kind":"RestrictedPage","title":"Page 1397 (in no courses)","link":"https://radiopaedia.org/admin/restricted_pages/1397"},{"id":2238,"kind":"Course","title":"Toxic \u0026 Metabolic Brain Disorders in Adults - page 2238","link":"https://radiopaedia.org/courses/toxic-and-metabolic-brain-disorders/pages/2238"},{"id":2238,"kind":"Course","title":"Toxic \u0026 Metabolic Brain Disorders in Adults Peer Review - page 2238","link":"https://radiopaedia.org/courses/toxic-and-metabolic-brain-disorders-peer-review/pages/2238"}],"stem":"\u003cp\u003eA 50-year-old woman with history of suicide attempts, last seen well 2 days ago, is found down with a reduced level of consciousness. Rapid initial laboratory assessment was abnormal and she is assessed with the MRI shown. What is the most likely diagnosis?\u003c/p\u003e","menuLinks":[{"text":"Report problem with question","url":"https://docs.google.com/forms/d/e/1FAIpQLSfO3soWYhOjJ7yErSysyCe5V4A1CqW7WK3rDA7MtAkecMGqNw/viewform?entry.1624461248\u0026entry.553583435=https://radiopaedia.org/questions/2586"}],"attemptsPercentages":[{"alternativeId":"12692","percentage":59},{"alternativeId":"12694","percentage":1},{"alternativeId":"12690","percentage":29},{"alternativeId":"12691","percentage":9},{"alternativeId":"12693","percentage":2}],"promptToLogin":false,"questionManager":false,"articleId":"osmotic-demyelination-syndrome"}