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Case - Hypoglycemia (Stroke Mimic)

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Hypoglycemia is another stroke mimic.

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Patients with severe hypoglycemia

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get cytotoxic edema,

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and they'll get restricted diffusion,

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especially in the occipital

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lobes and splenium of the corpus callosum.

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But other sites are also seen, hippocampi, basal ganglia,

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deep white matter and occasionally posterior

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fossa structures.

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These are two patients who had profound hypoglycemia

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and had visual disturbance.

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This patient has restricted diffusion in

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the bilateral occipital lobes, as you can see on the DWI

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and ADC maps, and has some mild swelling

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and FLARE hyperintensity.

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But the MRA was normal.

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So with normal vessels profound hypoglycemia,

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this is consistent with profound hypoglycemia.

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Here's another patient

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who also had profound hypoglycemia.

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Posterior temporal and occipital distribution and

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that patient also presented with visual changes.

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These are images of a 45 year old female

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who had type 1 diabetes and was found

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by her husband on the couch unresponsive.

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She had a glucose of less than 40,

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and on further review,

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they thought that the glucose may have been that low

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for approximately six hours.

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These are diffusion and ADC maps

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and you can see there's restricted diffusion in the

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occipital and posterior temporal lobes,

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and it extends up into the parietal lobes,

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and there's also involvement of the bilateral frontal lobes.

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Note there's some sparing of the perirolandic region,

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which would be a little

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unusual for acute hypoxia

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and the patient

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had refractory hypoglycemia.

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They eventually changed it,

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but she had these persistent changes over multiple MRs.

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We can also look at the FLARE images.

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And in those regions of restricted diffusion,

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you can see some mild FLARE hyperintensity, as well.

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Note there's just involvement of cortex,

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a lot of involvement in cortex,

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not much involvement of subcortical white matter

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to be a little unusual for stroke.

Report

Faculty

Pamela W Schaefer, MD, FACR

Professor of Radiology, Vice Chair of Education

Massachusetts General Hospital

Tags

Vascular Imaging

Neuroradiology

Neuro

Metabolic

MRI

Head and Neck

Brain

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