Presentation
History of fasting followed by excessive alcohol drinking at evening presented in coma.
Patient Data
T2/FLAIR hyperintensity noted involving the bilateral insular cortex, bilateral hippocampus, anterior temporal lobe, cingulate gyrus and bilateral basal ganglia showing strong diffusion restriction. Affected grey matter are swollen and appears hypointense on T1.
Few T2/FLAIR Hyperintense foci also noted in the right occipital lobe and bilateral cerebellar hemisphere showing restriction on DWI suggest acute infarct.
Confluent areas of T2/FLAIR hyperintensity in the bilateral periventricular white matter and centrum semiovale due to small vessel ischemic changes.
Case Discussion
Symmetrical T2/FLAIR hyperintensity involving bilateral insular cortex, anterior and medial temporal lobe and basal ganglia with restricted diffusion on DWI and sparing of thalamus suggest hypoglycemic encephalopathy. The patient was hypoglycemic and random blood sugar (RBS) was 30 mg/dL.
Hypoxia can also have similar findings on imaging however it involves the thalamus and cerebellum in particular. It is often associated with a history of cardiac arrest.
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