J Clin Neurol.  2010 Jun;6(2):104-108. 10.3988/jcn.2010.6.2.104.

Lateralization of Hypoglycemic Encephalopathy: Evidence of a Mechanism of Selective Vulnerability

• Lee SH
• Kang CD
• Kim SS
• Tae WS
• Lee SY
• Kim SH
• Koh SH

• KMID: 2287642
• DOI: http://doi.org/10.3988/jcn.2010.6.2.104

Abstract

BACKGROUND
One of the characteristics of hypoglycemic encephalopathy (HE) is selective vulnerability of different brain regions.
CASE REPORT
We observed a patient with unilateral HE affecting the right internal capsule and the subcortical white matter. The patient had a preexisting stroke in the opposite hemisphere. The hemisphere that was affected by HE exhibited greater regional blood flow (single positron-emission tomography) and higher fractional anisotropy (diffusion-tensor imaging) than the unaffected hemisphere.
CONCLUSIONS
This case suggests that the degree of metabolism required to maintain the function of brain structures and neuronal integrity is an important factor determining the selective vulnerability in HE.

Keyword

hypoglycemic encephalopathy; selective vulnerability; unilateral involvement; degree of metabolism

MeSH Terms

Anisotropy
Brain
Humans
Internal Capsule
Neurons
Regional Blood Flow
Stroke

Figure

• 

  Fig. 1 The initial and follow-up diffusion-weighted images of the patient. The initial images (A-C) demonstrate lateralizing high-signal-intensity lesions in the right internal capsule, periventricular WM, and frontal cortex. On the follow-up images (D-F), the initial hyperintense lesions disappear. WM: white matter.

• 

  Fig. 2 The diffusion tensor images of the patient. A: Color-coded directional map of the FA demonstrates the relatively lower integrity in the left internal capsule. B: The ROIs positioned on the internal capsule that were used to calculate the FA values. C and D: Reconstructed three-dimensional tractography shows the relatively scanty descending fibers in the left hemisphere. The gray scale bar represents the FA value. FA: fractional anisotropy, ROIs: regions of interest.

• 

  Fig. 3 T1 MR images (A, D and G), coregistered MRI to SPECT (B, E and H), and SPECT (C, F and I) demonstrate the relatively lower rCBF in the left hemisphere. The four ROIs (red, green, yellow, and blue lines in A and C) are positioned to calculate the asymmetric index. rCBF: regional cerebral blood flow, ROIs: regions of interest.

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