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<meta name="DC.Title" content="Diffusion MR Imaging of Hypoglycemic Encephalopathy" />
<meta name="DC.Identifier" content="10.3174/ajnr.A1856" />
<meta name="DC.Date" content="2010-03-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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Indicates open access to non-subscribers at www.ajnr.org" />
<meta name="DC.AccessRights" content="open-access" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: MR imaging features of HE have not been fully established. The purpose of this study was to determine the topographic distribution and DWI findings of HE.

MATERIALS AND METHODS: We retrospectively evaluated HE MR imaging ( n = 11). The topographic distribution of the lesions was evaluated on routine MR imaging, and DWI SI and ADC values were assessed. The ADC value of involved lesions was compared with the noninvolved subcortical WM area by use of the paired t test.

RESULTS: MR images demonstrated bilateral diffusion-restrictive lesions in the posterior limb of the IC ( n = 6), cerebral cortex ( n = 8), CR ( n = 7), CS ( n = 9), hippocampus ( n = 4), and BG ( n = 1). The mean ADC value of lesions was 448.82 ± 92.34 × 10−6 mm2/s compared with the mean ADC value of noninvolved lesions (837.72 ± 62.14 × 10−6 mm2/s); this difference was statistically significant ( P &lt; .000). The lesions showed complete resolution on follow-up DWI for 6 patients. Three patients with cortical involvement of ≥2 lobes showed partial recovery or death, but most of the other patients with WM involvement or cortical involvement in only 1 lobe experienced complete recovery.

CONCLUSIONS: The topographic localization of the lesions was the posterior limb of the IC, cerebral cortex, CR, CS, hippocampus, and BG. Most HE lesions probably correspond to areas of reversible cytotoxic edema as seen on DWI, which can predict the prognosis of HE according to the degree of lesion extent.

ADC
:   apparent diffusion coefficient
APN
:   acute pyelonephritis
BG
:   basal ganglia
BST
:   blood sugar test
CC
:   corpus callosum
CR
:   corona radiata
CS
:   centrum semiovale
DM
:   diabetes mellitus
DWI
:   diffusion-weighted image
FLAIR
:   fluid-attenuated inversion recovery
FL
:   frontal lobe
HE
:   hypoglycemic encephalopathy
IC
:   internal capsule
IN
:   insular lobe
MCA
:   middle cerebral artery
MRI
:   MR imaging
NSA
:   number of signals averaged
OC
:   occipital lobe
PA
:   parietal lobe
SI
:   signal intensity
TL
:   temporal lobe
WM
:   white matter" />
<meta name="DC.Contributor" content="E.G. Kang" />
<meta name="DC.Contributor" content="S.J. Jeon" />
<meta name="DC.Contributor" content="S.S. Choi" />
<meta name="DC.Contributor" content="C.J. Song" />
<meta name="DC.Contributor" content="I.K. Yu" />
<meta name="article:published_time" content="2010-03-01" />
<meta name="article:section" content="Brain" />
<meta name="citation_title" content="Diffusion MR Imaging of Hypoglycemic Encephalopathy" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;MR imaging features of HE have not been fully established. The purpose of this study was to determine the topographic distribution and DWI findings of HE.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We retrospectively evaluated HE MR imaging (&lt;i&gt;n&lt;/i&gt; = 11). The topographic distribution of the lesions was evaluated on routine MR imaging, and DWI SI and ADC values were assessed. The ADC value of involved lesions was compared with the noninvolved subcortical WM area by use of the paired &lt;i&gt;t&lt;/i&gt; test.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;MR images demonstrated bilateral diffusion-restrictive lesions in the posterior limb of the IC (&lt;i&gt;n&lt;/i&gt; = 6), cerebral cortex (&lt;i&gt;n&lt;/i&gt; = 8), CR (&lt;i&gt;n&lt;/i&gt; = 7), CS (&lt;i&gt;n&lt;/i&gt; = 9), hippocampus (&lt;i&gt;n&lt;/i&gt; = 4), and BG (&lt;i&gt;n&lt;/i&gt; = 1). The mean ADC value of lesions was 448.82 ± 92.34 × 10&lt;sup&gt;−6&lt;/sup&gt; mm&lt;sup&gt;2&lt;/sup&gt;/s compared with the mean ADC value of noninvolved lesions (837.72 ± 62.14 × 10&lt;sup&gt;−6&lt;/sup&gt; mm&lt;sup&gt;2&lt;/sup&gt;/s); this difference was statistically significant (&lt;i&gt;P&lt;/i&gt; &amp;lt; .000). The lesions showed complete resolution on follow-up DWI for 6 patients. Three patients with cortical involvement of ≥2 lobes showed partial recovery or death, but most of the other patients with WM involvement or cortical involvement in only 1 lobe experienced complete recovery.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;The topographic localization of the lesions was the posterior limb of the IC, cerebral cortex, CR, CS, hippocampus, and BG. Most HE lesions probably correspond to areas of reversible cytotoxic edema as seen on DWI, which can predict the prognosis of HE according to the degree of lesion extent.&lt;/p&gt;" />
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<meta name="citation_reference" content="citation_journal_title=Stroke;citation_author=J. Bottcher;citation_author=A. Kunze;citation_author=C. Kurrat;citation_title=Localized reversible reduction of apparent diffusion coefficient in transient hypoglycemia-induced hemiparesis;citation_volume=36;citation_year=2005;citation_pmid=15692119;citation_doi=10.1161/01.STR.0000155733.65215.c2" />
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<meta name="twitter:title" content="Diffusion MR Imaging of Hypoglycemic Encephalopathy" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: MR imaging features of HE have not been fully established. The purpose of this study was to determine the topographic distribution and DWI findings of HE.

MATERIALS AND METHODS: We retrospectively evaluated HE MR imaging ( n = 11). The topographic distribution of the lesions was evaluated on routine MR imaging, and DWI SI and ADC values were assessed. The ADC value of involved lesions was compared with the noninvolved subcortical WM area by use of the paired t test.

RESULTS: MR images demonstrated bilateral diffusion-restrictive lesions in the posterior limb of the IC ( n = 6), cerebral cortex ( n = 8), CR ( n = 7), CS ( n = 9), hippocampus ( n = 4), and BG ( n = 1). The mean ADC value of lesions was 448.82 ± 92.34 × 10−6 mm2/s compared with the mean ADC value of noninvolved lesions (837.72 ± 62.14 × 10−6 mm2/s); this difference was statistically significant ( P &lt; .000). The lesions showed complete resolution on follow-up DWI for 6 patients. Three patients with cortical involvement of ≥2 lobes showed partial recovery or death, but most of the other patients with WM involvement or cortical involvement in only 1 lobe experienced complete recovery.

CONCLUSIONS: The topographic localization of the lesions was the posterior limb of the IC, cerebral cortex, CR, CS, hippocampus, and BG. Most HE lesions probably correspond to areas of reversible cytotoxic edema as seen on DWI, which can predict the prognosis of HE according to the degree of lesion extent.

ADC
:   apparent diffusion coefficient
APN
:   acute pyelonephritis
BG
:   basal ganglia
BST
:   blood sugar test
CC
:   corpus callosum
CR
:   corona radiata
CS
:   centrum semiovale
DM
:   diabetes mellitus
DWI
:   diffusion-weighted image
FLAIR
:   fluid-attenuated inversion recovery
FL
:   frontal lobe
HE
:   hypoglycemic encephalopathy
IC
:   internal capsule
IN
:   insular lobe
MCA
:   middle cerebral artery
MRI
:   MR imaging
NSA
:   number of signals averaged
OC
:   occipital lobe
PA
:   parietal lobe
SI
:   signal intensity
TL
:   temporal lobe
WM
:   white matter" />
<meta name="og-title" property="og:title" content="Diffusion MR Imaging of Hypoglycemic Encephalopathy" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/31/3/559" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: MR imaging features of HE have not been fully established. The purpose of this study was to determine the topographic distribution and DWI findings of HE.

MATERIALS AND METHODS: We retrospectively evaluated HE MR imaging ( n = 11). The topographic distribution of the lesions was evaluated on routine MR imaging, and DWI SI and ADC values were assessed. The ADC value of involved lesions was compared with the noninvolved subcortical WM area by use of the paired t test.

RESULTS: MR images demonstrated bilateral diffusion-restrictive lesions in the posterior limb of the IC ( n = 6), cerebral cortex ( n = 8), CR ( n = 7), CS ( n = 9), hippocampus ( n = 4), and BG ( n = 1). The mean ADC value of lesions was 448.82 ± 92.34 × 10−6 mm2/s compared with the mean ADC value of noninvolved lesions (837.72 ± 62.14 × 10−6 mm2/s); this difference was statistically significant ( P &lt; .000). The lesions showed complete resolution on follow-up DWI for 6 patients. Three patients with cortical involvement of ≥2 lobes showed partial recovery or death, but most of the other patients with WM involvement or cortical involvement in only 1 lobe experienced complete recovery.

CONCLUSIONS: The topographic localization of the lesions was the posterior limb of the IC, cerebral cortex, CR, CS, hippocampus, and BG. Most HE lesions probably correspond to areas of reversible cytotoxic edema as seen on DWI, which can predict the prognosis of HE according to the degree of lesion extent.

ADC
:   apparent diffusion coefficient
APN
:   acute pyelonephritis
BG
:   basal ganglia
BST
:   blood sugar test
CC
:   corpus callosum
CR
:   corona radiata
CS
:   centrum semiovale
DM
:   diabetes mellitus
DWI
:   diffusion-weighted image
FLAIR
:   fluid-attenuated inversion recovery
FL
:   frontal lobe
HE
:   hypoglycemic encephalopathy
IC
:   internal capsule
IN
:   insular lobe
MCA
:   middle cerebral artery
MRI
:   MR imaging
NSA
:   number of signals averaged
OC
:   occipital lobe
PA
:   parietal lobe
SI
:   signal intensity
TL
:   temporal lobe
WM
:   white matter" />
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      <h1 class="highwire-cite-title" id="page-title">Diffusion MR Imaging of Hypoglycemic Encephalopathy</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">E.G. Kang</span>, <span class="highwire-citation-author" data-delta="1">S.J. Jeon</span>, <span class="highwire-citation-author" data-delta="2">S.S. Choi</span>, <span class="highwire-citation-author" data-delta="3">C.J. Song</span> and <span class="highwire-citation-author" data-delta="4">I.K. Yu</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">March 2010,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">559-564; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A1856 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-9604--61543076936" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">E.G. Kang </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=E.G.%2BKang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kang%20E&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AE.G.%2BKang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">S.J. Jeon </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.J.%2BJeon%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Jeon%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AS.J.%2BJeon%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">S.S. Choi </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.S.%2BChoi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Choi%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AS.S.%2BChoi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">C.J. Song </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.J.%2BSong%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Song%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AC.J.%2BSong%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">I.K. Yu </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=I.K.%2BYu%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Yu%20I&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AI.K.%2BYu%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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<p id="p-4"><strong>BACKGROUND AND PURPOSE:</strong> MR imaging features of HE have not been fully established. The purpose of this study was to determine the topographic distribution and DWI findings of HE.</p>
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<p id="p-5"><strong>MATERIALS AND METHODS:</strong> We retrospectively evaluated HE MR imaging (<em>n</em> = 11). The topographic distribution of the lesions was evaluated on routine MR imaging, and DWI SI and ADC values were assessed. The ADC value of involved lesions was compared with the noninvolved subcortical WM area by use of the paired <em>t</em> test.</p>
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<p id="p-6"><strong>RESULTS:</strong> MR images demonstrated bilateral diffusion-restrictive lesions in the posterior limb of the IC (<em>n</em> = 6), cerebral cortex (<em>n</em> = 8), CR (<em>n</em> = 7), CS (<em>n</em> = 9), hippocampus (<em>n</em> = 4), and BG (<em>n</em> = 1). The mean ADC value of lesions was 448.82 ± 92.34 × 10<sup>−6</sup> mm<sup>2</sup>/s compared with the mean ADC value of noninvolved lesions (837.72 ± 62.14 × 10<sup>−6</sup> mm<sup>2</sup>/s); this difference was statistically significant (<em>P</em> &lt; .000). The lesions showed complete resolution on follow-up DWI for 6 patients. Three patients with cortical involvement of ≥2 lobes showed partial recovery or death, but most of the other patients with WM involvement or cortical involvement in only 1 lobe experienced complete recovery.</p>
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<p id="p-7"><strong>CONCLUSIONS:</strong> The topographic localization of the lesions was the posterior limb of the IC, cerebral cortex, CR, CS, hippocampus, and BG. Most HE lesions probably correspond to areas of reversible cytotoxic edema as seen on DWI, which can predict the prognosis of HE according to the degree of lesion extent.</p>
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</div><div class="section glossary" id="glossary-1"><h2>Abbreviations</h2><dl id="def-list-1"><dt id="def-item-1">ADC<span class="def-item-dt-sep"></span></dt><dd>apparent diffusion coefficient<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">APN<span class="def-item-dt-sep"></span></dt><dd>acute pyelonephritis<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">BG<span class="def-item-dt-sep"></span></dt><dd>basal ganglia<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">BST<span class="def-item-dt-sep"></span></dt><dd>blood sugar test<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">CC<span class="def-item-dt-sep"></span></dt><dd>corpus callosum<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">CR<span class="def-item-dt-sep"></span></dt><dd>corona radiata<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">CS<span class="def-item-dt-sep"></span></dt><dd>centrum semiovale<span class="def-item-dd-sep"></span></dd><dt id="def-item-8">DM<span class="def-item-dt-sep"></span></dt><dd>diabetes mellitus<span class="def-item-dd-sep"></span></dd><dt id="def-item-9">DWI<span class="def-item-dt-sep"></span></dt><dd>diffusion-weighted image<span class="def-item-dd-sep"></span></dd><dt id="def-item-10">FLAIR<span class="def-item-dt-sep"></span></dt><dd>fluid-attenuated inversion recovery<span class="def-item-dd-sep"></span></dd><dt id="def-item-11">FL<span class="def-item-dt-sep"></span></dt><dd>frontal lobe<span class="def-item-dd-sep"></span></dd><dt id="def-item-12">HE<span class="def-item-dt-sep"></span></dt><dd>hypoglycemic encephalopathy<span class="def-item-dd-sep"></span></dd><dt id="def-item-13">IC<span class="def-item-dt-sep"></span></dt><dd>internal capsule<span class="def-item-dd-sep"></span></dd><dt id="def-item-14">IN<span class="def-item-dt-sep"></span></dt><dd>insular lobe<span class="def-item-dd-sep"></span></dd><dt id="def-item-15">MCA<span class="def-item-dt-sep"></span></dt><dd>middle cerebral artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-16">MRI<span class="def-item-dt-sep"></span></dt><dd>MR imaging<span class="def-item-dd-sep"></span></dd><dt id="def-item-17">NSA<span class="def-item-dt-sep"></span></dt><dd>number of signals averaged<span class="def-item-dd-sep"></span></dd><dt id="def-item-18">OC<span class="def-item-dt-sep"></span></dt><dd>occipital lobe<span class="def-item-dd-sep"></span></dd><dt id="def-item-19">PA<span class="def-item-dt-sep"></span></dt><dd>parietal lobe<span class="def-item-dd-sep"></span></dd><dt id="def-item-20">SI<span class="def-item-dt-sep"></span></dt><dd>signal intensity<span class="def-item-dd-sep"></span></dd><dt id="def-item-21">TL<span class="def-item-dt-sep"></span></dt><dd>temporal lobe<span class="def-item-dd-sep"></span></dd><dt id="def-item-22">WM<span class="def-item-dt-sep"></span></dt><dd>white matter</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">Copyright © American Society of Neuroradiology</li></ul><div class="license" id="license-1"><p id="p-3">Indicates open access to non-subscribers at <a href="http://www.ajnr.org">www.ajnr.org</a></p></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/31/3/559.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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