Utility of Diffusion-Weighted Magnetic Resonance Imaging for Predicting a Prognosis in Hypoglycemic Encephalopathy: Two Case Reports

Cases:

Case 1: A 71-year-old male with a long history of chronic alcoholism was transferred to our emergency department because of a disturbance of consciousness. On arrival, his Glasgow Coma Scale (GCS) was E1V1M2 (4/15) and blood glucose level was 30 mg/dL.

Case 2: A 66-year-old female with dermatomyositis and a long history of steroid-induced diabetes mellitus, who was treated with a sulfonylurea, was transferred to our department because of an altered mental state. Her GCS was E3V2M4 (9/15) and blood glucose level was 32 mg/dL. We observed abnormalities on diffusion-weighted magnetic resonance images (DWI-MRI) in both cases.

Outcomes: Although intravenous thiamine and glucose was immediately administered because of suspected hypoglycemic encephalopathy, case 1 died after 3 days, and case 2 remained in a persistent vegetative state more than 90 days after onset.

Conclusion: Unlike conventional MRI, DWI-MRI abnormalities can be used as predictors of poor prognosis in patients with severe hypoglycemia.