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Rapid improvement of diffusion-weighted imaging abnormalities after glucose infusion in hypoglycaemic coma

Diffusion-weighted imaging (DWI) may detect hyperintense lesions in patients with transient hypoglycaemia-induced hemiparesis or coma, which are completely reversible after glucose infusion.1–3 In vivo animal studies have documented the visualisation of such hypoglycaemia-induced changes of signal intensity and the reversal by glucose intake in detail.4 However, the time necessary for hyperintense lesions on DWI to disappear after glucose infusion in humans is still unclear. We treated a patient in a hypoglycaemic coma with DWI abnormalities in the splenium of the corpus callosum and the bilateral posterior limbs of the internal capsules, which were drastically improved 2 h after glucose infusion.

A 54-year-old woman was taken to an emergency department after being found in an unresponsive state. The patient had had type 2 diabetes mellitus, hypertension and hyperlipidaemia for 7 years, controlled by oral drugs. On arrival, she was comatose (Glasgow Coma Scale 4; E1, V1, M2). Her pupils exhibited isocoria (2 mm/2 mm) and were reactive to light. Tetraparesis and decerebrate rigidity to pain was evident. Her blood pressure was 91/40 mm Hg and her heart rate …