Abstract
We describe 2 cases with different clinical courses of diffusion-weighted MRI of hypoglycemic encephalopathy with reversible high signal intensity localized in the posterior limb of the internal capsule. In the first patient (a man aged 75 years), the area of abnormal high signal intensity was situated bilaterally; however, he had right-dominant motor weakness before being brought to our hospital and was in a deep coma on arrival. This patient was treated adequately, and the second image taken using diffusion-weighted MRI was normal six days after onset. He left the hospital without neurological deficits within ten days after onset. In the second patient (a woman aged 92 years), the area of abnormal high signal intensity was also situated bilaterally; however, she had left dominant motor weakness and disturbance in consciousness on arrival. The findings in this patient were initially misinterpreted as acute cerebral infarction, so she was not supplemented with adequate glucose until 48 hours after onset. The second image taken using diffusion-weighted MRI revealed a new lesion in the corona radiata. Though the diffusion-weighted MR image returned to normal one week after onset, it took more than one month for her to recover her original activities of daily living. Although cerebral infarction and hyperglycemia exhibit similar findings using diffusion-weighted MRI, it is important to consider the possibility of hypoglycemic encephalopathy because it can be effectively treated and reversed, leading to complete recovery.
