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Table 1 Summary of clinical and imaging findings from all papers describing brain imaging findings in hypoglycaemia

From: Acute symptomatic hypoglycaemia mimicking ischaemic stroke on imaging: a systemic review

Author, Yeara Number of cases CT or MR Time to scan Uni or bi-lateral imaging signs Cortical lesions Deep lesions Lesion enhancement Cause of hypo-glycaemia Symptoms at presentation Outcome Lowest blood glucose Duration of hypo-glycaemia
Severe neurological deficit and poor clinical outcome
Richardson, 1981 [42] 1 CT Day 1, Day 7, Day 26 Bilateral Y N Y Unknown Coma Death 26mg/dl 12-24 hours
Iwai, 1987 [3] 1 CT Day 1, Day 3, Day 5, Day 25 Unilateral Y N Y Insulin overdose Coma Vegetative 10 mg/dl 12-24 hours
Meer, 1988 [23]
[French]
1 CT& MR Not recorded Bilateral N Y Y Insulin overdose Coma Persistent hemiparesis and dysphasia Not recorded “Prolonged”
Berlit, 1990 [2]
[German]
1 CT Day 1, Day 3, 3 months Bilateral Y Y Y Insulin overdose Coma Vegetative 60mg/dl 12-24 hours
Isono, 1993 [19] [Japanese] 1 CT & MR Day 2, Day 4, Day 9, Day 16, Day 23, Day 82 Bilateral Y N Y ? Coma Vegetative ? Unknown
Boeve, 1995 [9] 1 CT & MR Day 1, Day 3 Bilateral Y N N Insulin overdose Coma Persistent severe cognitive impairment and seizures (77 mg/dl after treatment) Unknown (probably >24 hours)
Fujioka, 1997 [16] 4 CT & MR Multiple studies, Day 1 to 1 year Bilateral Y Y Y Insulin overdose (2);Oral hypoglycaemic agent overdose (2) Coma Vegetative All <0.85 mmol/l (<15mg/dl) All 6–12 hours
Cubo, 1998 [13] [Spanish] 1 CT & MR Day 1, Day 7, 1 year Bilateral N Y - Oral hypoglycaemic agent overdose Coma Vegetative 28 mg/dl Unknown
Purucker, 2000 [5] 1 CT Day 1, Day 7 Bilateral N Y - Oral hypoglycaemic agent overdose Coma Death ‘below the detection limit’ 12-24 hours
Bakshi, 2000 [7] 1 CT & MR Day 2, Day 25 Bilateral N Y - Insulin overdose Coma Death (230 mg/dl after treatment) >24 hours
Finelli, 2001 [15] 1 CT & MR Day 1, Day 4, Day 5 Bilateral Y Y Y (basal ganglia lesions only) Insulin overdose Coma Death 23 mg/dl 12-24 hours
Cheng, z2001 [12] 1 CT & MR 1 week, 2 months Bilateral N Y Y Not recorded (diabetic) Coma Vegetative Not recorded Not recorded
Chan, 2003 [11] 1 CT & MR Day 1 Bilateral Y N N Unknown (insulin overdose or insulin receptor antibodies) Seizures; coma Death <20 mg/dl Unknown
Garambois, 2004 [17] [French] 1 CT & MR Day 1, Day 5, Day 6, Day 27 Bilateral Y N - Insulin overdose and alcohol Coma Death <1 mmo/l (<18mg/dl) 6-12 hours
Jung, 2005 [20] 1 CT & MR Day1, Day 3 Bilateral Y Y - Insulin overdose Coma Vegetative 33 mg/dl 6-12 hours
Yoneda, 2005 [27] 1 CT & MR Day 1, Day 22 Bilateral Y Y - Overdose of insulin and oral hypoglycaemic agent Coma Death [11.2mmol/l (201mg/dl) after treatment] >24 hours
Lo, 2006 [34] 1 MR Day 6 Bilateral Y N - Oral hypoglycaemic agent overdose Seizure; coma Death 2.1mmol/l (38mg/dl) <6 hours
Maekawa, 2006 [22] 1 CT & MR Day 1, Day 2 Day 7, Day 14, Day 24 Bilateral Y N - Insulin overdose Coma Fully dependent 36 mg/dl 12-24 hours
Mori, 2006 [24] 1 CT & MR Day 1, 2 weeks, 3 months Bilateral Y Y - Insulin overdose Coma Death 27mg/dl 4 hours
Yanagawa, 2006 [26] 1 CT & MR Day 1, Day 5, Day 50 Bilateral Y N - Insulin overdose Coma Fully dependent 17mg/dl Unknown
Kim and Koh, 2007 [33] 1 MR Day 2 Bilateral N Y - Unknown (diabetic) Coma Death 14 mg/dl Unknown
Megarbane, 2007 [36] 1 MR Day 3, Day 30 Bilateral Y N - Insulin overdose Coma Death Not recordedb 6-12 hours
Roh, 2008 [39] 1 MR Day 7 Bilateral N Y N Unknown Coma Vegetative 25mg/dl Unknown
Ma, 2009 [42] 17 MR Day 1 Bilateral (15) Y (12) Y (10) - Insulin overdose (8) Poor oral intake in diabetic (6) Oral hypoglycaemic agent overdose (1) Coma Vegetative (14) Fully dependent (1) Range 15-40mg/dl Unknown
Tong and Gong, 2009 [43] 1 MR Day 3 Bilateral Y Y - Oral hypoglycaemic agent overdose Coma Death 20mg/dl 20-24 hours
Intermediate neurological severity and clinical outcome
Chalmers, 1991 [10] 1 CT& MR Day 1, 6 months Unilateral Y N - Insulin overdose Coma Persistent memory impairment 1.8mmol/l (32mg/dl) 6-12 hours
Holemans, 2001 [18] 1 CT & MR Day 1, Day 5 Bilateral Y N - Insulin overdose Somnolence Impaired memory - delayed but full recovery Not recorded >24 hours
Batista, 2008 [8] 1 CT & MR Day 1 Bilateral Y N - Insulin overdose Coma Persistent impaired long-term memory 34mg/dl 6-12 hours
Good clinical outcome
Koppel, 1993 [4] 1 CT Day 1, Day 2 Unilateral N Y N Insulin overdose Hemiparesis then coma Full recovery 40 mg/dl <6 hours
Endo, 2003 [14] [Japanese] 1 CT & MR Day 1 Bilateral N Y - ? Coma Full recovery ? ?
Okamoto, 2003 [37] 1 MR Day 1, Day 2 Bilateral N Y N Not recorded (diabetic) Coma Full recovery Not recorded Not recorded
Aoki, 2004 [29] 1 MR Day 1, Day 10 Bilateral Y Y - Oral hypoglycaemic agent overdose Coma Full recovery 20 mg/l 12-24 hours
Shirayama, 2004 [25] 1 CT & MR Day 1 Unilateral N Y - Insulin overdose Coma; Left hemiparesis Full recovery 0.9mmol/l (16mg/dl) 5 hours
Bottcher, 2005 [30] 1 MR Day 1, Day 3 Bilateral (R>L) N Y - Oral hypoglycaemic agent overdose Hemiparesis; somnolent Full recovery 1.71 mmol/l (31mg/dl) 12-24 hours
Takeuchi, 2005 [40] [Japanese] 1 MR Day 1 Bilateral N Y - ? Coma Full recovery 28mg/dl <6 hours
Cordonnier, 2005 [31] 1 MR Day 1 Unilateral N Y - Pancreatic tumour Hemiparesis Full recovery 2.2 mmol/l (40mg/dl) <6 hours
Doherty, 2005 [32] 2 MR Day 1 Bilateral N Y - Insulin overdose and alcohol Somnolence Full recovery 57mg/dl Unknown
MR Day 1 Bilateral N Y - Insulin overdose Coma Full recovery (56mg/dl after treatment) Unknown
Pandian, 2005 [38] 1 MR Day 1 Midline N Y - Unknown (diabetic) Coma Full recovery Not recorded Unknown
Lo, 2006 [34] 1 MR Day 1 (45 minutes; 12 hours) Bilateral N Y - Oral hypoglycaemic agent overdose Coma Full recovery 1.9mmol/l 2(34mg/dl) <2 hours
Albayram, 2006 [28] 1 MR Day 1 Unilateral N Y - Insulin-secreting liver metastsis Hemiparesis Full recovery 32mg/dl 6 hours
Kim et al., 2007 [21] 3 MR Day 1 Unilateral N Y - Oral hypoglycaemic agent overdose Somnolent; hemiparesis Full recovery 38mg/dl 8 hours
CT & MR Day 1, Day 3 Midline N Y - Insulin overdose Somnolent Full recovery 21mg/dl Unknown
CT & MR Day 1, Day 9 Midline N Y - Insulin overdose Coma; seizures Full recovery 3mg/dl 8 hours
Maruya, 2007 [35] 1 MR Day 1, Day 3 Bilateral N Y - Oral hypoglycaemic agent overdose Coma Full recovery 1.8 mmol/l (32mg/dl) Unknown
Terakawa, 2007 [41] 1 MR Day 1, Day 2 Unilateral and midline N Y - Insulin overdose Hemiparesis Full recovery 24mg/dl 6-12 hours
Ma, 2009 [42] 2 MR Day 1 Midline (1) N Y - Poor oral intake in diabetic Somnolent Full recovery   Unknown
Unilateral (1) N Y - Unknown Somnolent Full recovery   Unknown
  1. aSome studies appear more than once if they provided data on patients in more than one category.
  2. bIndividual’s data not recorded. Presented as part of a subgroup where n=4, with median blood glucose 0.7mmol/l (range 0.5 - 4.1mmol/l) (12mg/dl, range 9-73mg/dl).
  3. CT - computed tomography; MR - magnetic resonance.