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Rapid Regression of White Matter Changes in Hypoglycemic Encephalopathy

저혈당성 뇌병증에서 뇌백질 변화의 빠른 퇴행

  • Son, Sang-Wook (Department of Radiology, Dankook University Hospital) ;
  • Lee, Kye-Ho (Department of Radiology, Dankook University Hospital) ;
  • Yoo, Dong-Soo (Department of Radiology, Dankook University Hospital)
  • 손상욱 (단국대학교병원 영상의학과) ;
  • 이계호 (단국대학교병원 영상의학과) ;
  • 유동수 (단국대학교병원 영상의학과)
  • Received : 2014.09.23
  • Accepted : 2014.11.26
  • Published : 2014.12.31

Abstract

Purpose : In a previous report, it took several days for white matter lesions to regress in hypoglycemic encephalopathy. We present a case of rapid diffusion-weighted image (DWI) changes in hypoglycemic encephalopathy. Case Report: A 58-year-old male patient was found semi-comatous with the only abnormality in his laboratory tests showing hypoglycemia (44 mg/dL). After rapid correction of glucose level, immediate brain DWI showed bilateral subcortical white matter lesions. After about 5 hours, follow-up DWI showed resolved subcortical white matter lesions, with newly-appeared bilateral fronto-temporo-parietal cortical lesions. Conclusion: Both white matter and cortex involvement in hypoglycemic encephalopathy has been shown in several reports, but rapid regression of white matter changes in hypoglycemic encephalopathy has been rarely reported. It is important to know that MR imaging changes in hypoglycemic encephalopathy can be made as quick as just a few-hour-long.

목적: 이전의 증례 보고에서는 저혈당성 뇌병증 환자의 뇌백질의 변화가 퇴행하기까지 수 일이 소요되었다. 본 저자들은 저혈당성 뇌병증에서 확산강조영상의 빠른 변화를 경험하였다. 이에 문헌 고찰과 함께 보고자 한다. 증례 보고: 58세 남자 환자가 반혼수 상태로 발견되었으나 혈액 검사 상 저혈당 (44 mg/dL)이 나타난 것 외 특이 소견이 없었다. 혈당 수치를 빠르게 교정한 후 곧바로 촬영한 뇌 확산강조영상에서 양쪽 피질하 백질의 병변이 관찰되었다. 5시간 후 재시행한 확산강조영상에서 피질하 백질이 회복된 대신 양쪽 전방측두두정엽 피질의 병변이 새로이 발견되었다. 결론: 저혈당성 뇌병증 환자에서 뇌백질과 피질이 모두 이상소견을 보이는 증례 보고는 이전에도 다수 있었지만 이처럼 뇌백질 변화가 빠른 퇴행을 보이는 증례는 거의 보고된 바 없다. 저자들은 저혈당성 뇌병증에서 자기공명 영상의 변화가 빠르게는 수 시간 내로도 나타날 수 있다는 걸 알리고자 한다.

Keywords

References

  1. Lee CY, Liou KC, Chen LA. Serial magnetic resonance imaging changes in hypoglycemic encephalopathy. Acta Neurol Taiwan 2013;22:22-25
  2. Auer RN. Progress review: hypoglycemic brain damage. Stroke 1986;17:699-708 https://doi.org/10.1161/01.STR.17.4.699
  3. Pelligrino D, Almquist LO, Siesjo BK. Effects of insulin-induced hypoglycemia on intracellular pH and impedance in the cerebral cortex of the rat. Brain Res 1981;221:129-147 https://doi.org/10.1016/0006-8993(81)91068-4
  4. Ma JH, Kim YJ, Yoo WJ, et al. MR imaging of hypoglycemic encephalopathy: lesion distribution and prognosis prediction by diffusion-weighted imaging. Neuroradiology 2009;51:641-649 https://doi.org/10.1007/s00234-009-0544-5
  5. Yoneda Y, Yamamoto S. Cerebral cortical laminar necrosis on diffusion-weighted MRI in hypoglycaemic encephalopathy. Diabet Med 2005;22:1098-1100 https://doi.org/10.1111/j.1464-5491.2005.01568.x
  6. Hasegawa Y, Formato JE, Latour LL, et al. Severe transient hypoglycemia causes reversible change in the apparent diffusion coefficient of water. Stroke 1996;27:1648-1655 https://doi.org/10.1161/01.STR.27.9.1648
  7. Aoki T, Sato T, Hasegawa K, Ishizaki R, Saiki M. Reversible hyperintensity lesion on diffusion-weighted MRI in hypoglycemic coma. Neurology 2004;63:392-393 https://doi.org/10.1212/01.WNL.0000130181.05016.68
  8. Hassel B, Boldingh KA, Narvesen C, Iversen EG, Skrede KK. Glutamate transport, glutamine synthetase and phosphateactivated glutaminase in rat CNS white matter. A quantitative study. J Neurochem 2003;87:230-237 https://doi.org/10.1046/j.1471-4159.2003.01984.x
  9. Fujioka M, Okuchi K, Hiramatsu KI, Sakaki T, Sakaguchi S, Ishii Y. Specific changes in human brain after hypoglycemic injury. Stroke 1997;28:584-587 https://doi.org/10.1161/01.STR.28.3.584
  10. Mori F, Nishie M, Houzen H, Yamaguchi J, Wakabayashi K. Hypoglycemic encephalopathy with extensive lesions in the cerebral white matter. Neuropathology 2006;26:147-152 https://doi.org/10.1111/j.1440-1789.2006.00656.x