Severe Hypoglycemic Brain Injury Associated with Diffuse Restricted Diffusion on MRI Brain Sparing Cerebellar Lobes (P10-7.006)

Abstract

<h3>Objective:</h3> Report a case of severe hypoglycemia-induced brain injury in an adult with MRI brain showing extensive diffusion restriction mimicking hypoxic brain injury. <h3>Background:</h3> Hypoglycemia is commonly seen in clinical practice, with most often benign outcome when appropriately treated. However, severe hypoglycemia may be associated with transient or permanent neurologic deficits. Irreversible diffuse brain injury is more often documented in the pediatric population, in particular neonatal, though devastating injury can also happen in adults. Energy deprivation and other chemical cascades lead to neuronal necrosis. Though some overlap exists and imaging shares some similarities, neurochemistry and brain lesion distribution of hypoglycemia differs markedly from ischemia. We present a case of severe, prolonged hypoglycemia leading to diffuse hypoglycemic brain injury. <h3>Design/Methods:</h3> Case report <h3>Results:</h3> 71-year-old male with history of insulin-dependent diabetes and depression with suicidal ideations who presented to the emergency room (ER) after being found unconscious with a serum glucose of 14 mg/dl. The patient was intubated for airway protection due to GCS at 9 but without significant hypoxia, saturating 93% on room air. Despite aggressive glucose replacement, he had several hypoglycemic episodes on a 27-hour span. Laboratory testing was remarkable only for elevated creatinine kinase of 3047 mg/dl, and presence of cannabis on urine drug screen. Patient remained comatose, with only preserved corneal reflexes after weaned off sedation. Non-epileptic myoclonus was also observed, confirmed by EEG. MRI brain revealed diffuse restricted diffusion, predominantly in the cerebral cortex and deep basal ganglia but sparing cerebellar lobes. Patient did not survive. <h3>Conclusions:</h3> Severe hypoglycemia leads to energy depletion and neuronal death with some overlap with ischemic brain injury though significant radiologic differences can help differentiate both pathophysiologic processes. Cerebellar involvement is uncommon compared to ischemic injury due to highly effective glucose transporter which can help differentiate both types of injury. <b>Disclosure:</b> Dr. Ribeiro has nothing to disclose. Dr. Gatchoff has nothing to disclose. Dr. Delpirou Nouh has nothing to disclose. Dr. Moon has nothing to disclose.