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.
Pamela W Schaefer, MD, FACR
Professor of Radiology, Vice Chair of Education
Massachusetts General Hospital
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