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NEUROLOGY 2008;71:e63
© 2008 American Academy of Neurology
Resident and Fellow Section

Teaching NeuroImage: Hippocampal involvement in a patient with hypoglycemic coma

Sang-Bae Ko, MD, Hee-Joon Bae, MD, PhD, Seung-Hoon Lee, MD, PhD and Byung-Woo Yoon, MD, PhD

From the Department of Neurology (S.-B.K., S.-H.L., B.-W.Y.), Seoul National University Hospital; and Seoul National University Bundang Hospital (H.-J.B.), Clinical Research Center for Stroke, Clinical Research Institute, Seoul National University, College of Medicine, Korea.

Address correspondence and reprint requests to Dr. Byung-Woo Yoon, Department of Neurology, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea bwyoon{at}snu.ac.kr

A 55-year-old diabetic man presented with coma for 2 days. Neurologic examination did not reveal any lateralizing signs and moderate hypoglycemia (43 mg/dL) was noted. Under the assumption of hypoglycemic coma, 50% dextrose solution of 50 mL was given IV, which normalized his mental status. Brain MRI showed high signal intensity lesions in the bilateral hippocampi from CA1 to CA3 areas (figure), which were vulnerable areas on experimental hypoglycemia.1 Neuropsychological examination showed marked anterograde amnesia, which persisted over 2 months.


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  		Figure Magnetic resonance image of the patient

Diffusion-weighted MRI shows hyperintense lesions in the bilateral hippocampi (A), which are hypointense on apparent diffusion coefficient map (B). Coronal view depicts that the abnormal signals are located in the hippocampal areas from CA1 to CA3 (C).

 

Supported by grants of the Korea Health 21 R&D Project, Ministry of Health and Welfare, Korea (A060171).

Disclosure: The authors report no disclosures.


   REFERENCE
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  1. Paschen W, Bengtsson F, Rohn G, Bonnekoh P, Siesjo B, Hossmann KA. Cerebral polyamine metabolism in reversible hypoglycemia of rat: relationship to energy metabolites and calcium. J Neurochem 1991;57:204–215.[Medline]




This Article
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