Abstract
We describe two cases in which abnormal findings from brain CT and MRI were seen in patients with extreme hypoglycemia and hyperglycemia. In case 1, an 82-year-old male suffering from diabetes mellitus experienced right hemiparesis. Brain CT and MRI were taken immediately as cerebral infarction was suspected. Brain CT showed the disappearance of fissures in the left occipital and parietal lobe, indicating cerebral edema. Diffusion weighted imaging (DWI) revealed areas of high intensity signal in the left cerebral cortices and subcortices, which was consistent with his right hemiparesis. Simultaneous blood glucose test revealed extreme hypoglycemia (11 mg/dl) and his right hemiparesis partially recovered after the administration of glucose. The cerebral edema which was initially shown on brain CT also improved 5 days later. In case 2, a 54-year-old male was admitted by an ambulance due to convulsions and diabetic ketoacidosis (blood glucose: 1,087 mg/dl). Brain CT taken before admitted to the ICU showed a high density region in the left putamen. He was treated with the administration of insulin and his convulsion disappeared. Three days later, blood glucose normalized, and he was discharged from the ICU. On T1-weighted MRI which was taken 2 days after the admission, a high intensity region was seen in the left putamen. This finding on brain CT partially disappeared at the 10th hospital day. In these 2 cases, hypoglycemia and hyperglycemia supposedly caused the abnormal findings on brain CT and MRI. The differentiation between the abnormal findings caused by extreme blood glucose value and cerebral infarction or hemorrhage should be carefully considered.
