In Ho Lee MD, Presenter: Nothing to Disclose

To describe the imaging and clinical findings of hyperglycemic encephalopathy.

We retrospectively reviewed imaging findings and medical records in 10 patients (M: F = 3:7, mean age: 69 years). All 10 patients underwent brain MR imaging due to various neurological symptoms and signs. We evaluated the location, MR signal intensity (SI), presence of calcification, hemorrhage, and enhancement pattern. We especially focused on locations of the high SI lesions on T1-weighted images (T1WI). We also evaluated the laboratory data including serum glucose level, HbA1C and clinical symptoms.  

All 10 patients showed high SI lesions at the basal ganglia on TIWI. Mean of serum glucose level and HbA1C was 187.4mg/dL in 10 patients (range: 105 – 410 mg/dL, normal< 100 mg/dL) and was 7.9 % in 6 patients (range: 6.1 – 10.6 %, normal< 6.0 %), respectively. All patients presented with specific symptoms such as dysarthria, involuntary movement or memory impairment. Most patients (n=9) showed unilateral lesion except 1 patient with bilateral lesions. The location of high SI lesions on T1WI are corpusstriatum (caudate nucleus, putamen, globus pallidus) (n=5), putamen (n=3), caudate nucleus (n= 1), and caudate nucleus and globus pallidus (n=1). Calcification and hemorrhage on gradient echo image were not noted in any patient. MR obtained 11 months later revealed disappearance of high SI at left caudate nucleus in 1 patient (patient #4). We also identified improvement of the patient’s symptom (dysarthria) during follow up.  

All patients showed unilateral or bilateral high SI lesions of the basal ganglia regardless of partial or total on T1WI. Although all lesions show non-specific imaging findings such as hepatic encephalopathy, unilateral high SI at the basal ganglia on T1WI and high level of HbA1C may be characteristic features of hyperglycemic encephalopathy. In addition, reversibility of high SI lesion on T1WI may be characteristic features, which is suggestive of clinical improvement of hyperglycemic encephalopathy. Also early recognition of these imaging and clinical characteristics can be helpful for early diagnosis of diabetes mellitus (DM) as well as early detection of poor controlled DM patients.  

Early recognition of these imaging and clinical characteristics can be helpful for early diagnosis of DM as well as early detection of poor controlled DM patients.

Lee, I, MR Imaging Findings of Hyperglycemic Encephalopathy.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12035605.html