Abstract
A 43-year-old woman with a 33-year type 1 diabetes history admitted for glycemic control and memory disturbance had suffered severe hypoglycemic attack without evidence of global circulatory disturbance at age 22, and manifested short-term memory disturbance and episodic memory impairment as hypoglycemic encephalopathy fallouts. On admission, HbA1c was 11.0%, a minimental state examination score of 27/30 suggested slightly mild cognitive impairment, and Wechsler Memory Scale Revised (WMS-R) showed apparent delayed recall disturbance (<50) with mildly impaired general memory verbal (77) and visual memory (71) function. Coronal brain magnetic resonance imaging (MRI) showed severe hippocampal atrophy accompanied by mild cerebral atrophy. Single photon emission computed tomography (SPECT) of the brain showed decreased HMPAO uptake in the medial temporal and frontal regions. Short-term memory disturbance, e.g, forgetting her last insulin injection, was seen on admission. Hypoglycemic status is recognized as causing selective neuronal degeneration from aspartate stress, especially in the dentate gyrus, cerebral cortex, and basal ganglia. Severe hippocampal atrophy with concomitant minor involvement of other cerebral regions after hypoglycemic attack may be responsible for amnesic memory deficit.
