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 | |||||