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Johnson PJ. Hypoglycaemia, hypoglycorrhachia, neuroglycopenia and glycaemic thresholds. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.13003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- P. J. Johnson
- Department of Veterinary Medicine and Surgery University of Missouri College of Veterinary Medicine Columbia Missouri USA
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Tomita N, Nakamura T, Sunden Y, Miyata H, Morita T. Temporal analysis of histopathology and cytokine expression in the rat cerebral cortex after insulin-induced hypoglycemia. Neuropathology 2020; 40:240-250. [PMID: 32080930 DOI: 10.1111/neup.12643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/24/2019] [Accepted: 12/25/2019] [Indexed: 11/30/2022]
Abstract
Hypoglycemic coma causes neuronal death in the cerebral neocortex; however, its unclear pathogenesis prevents the establishment of preventive measures. Inflammation plays a pivotal role in neuronal damage in the hypoglycemic state; however, the dynamics of glial cell activation or cytokine expression remain unknown. Here, we aimed to elucidate the spatiotemporal morphological changes of microglia and time-course cytokine expression profiles in the rat cerebral cortex after hypoglycemic coma. We performed histopathological and immunohistochemical (Iba1, neuronal nuclei, glial fibrillary acidic protein) analyses in the cingulate cortex and four areas of the neocortex: hindlimb area (HL), parietal cortex area 1 (Par1), parietal cortex area 2 (Par2), and perirhinal cortex (PRh). We measured tumor necrosis factor alpha (TNFα) and interleukin-6 messenger RNA (mRNA) expression by real-time reverse transcriptase-polymerase chain reaction. Necrotic neurons appeared in the neocortex as early as 3 h after hypoglycemic coma, while they were absent in the cingulate cortex. Neuronal nuclei-immunopositive neurons in the HL, Par2, and PRh were significantly less abundant than in the control at day 1. In Iba1 immunostaining, large rod-shaped cells were detected at 3-6 h after hypoglycemia, and commonly observed in the HL, Par2, and PRh. After 6 h, rod-shaped cells were rarely observed; instead, there was a prominent infiltration of hypertrophic and ameboid-shaped cells until day 7. The mRNA expression of TNFα was significantly higher than the control at 3-6 h after hypoglycemia in the neocortex, while it was significantly higher only at 3 h in the cingulate cortex. Our results indicate that early and transient appearance of rod-shaped microglia and persisting high TNFα expression levels characterize inflammatory responses to hypoglycemic neuronal damage in the cerebral neocortex, which might contribute to neuronal necrosis in response to transient hypoglycemic coma.
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Affiliation(s)
- Nagi Tomita
- Laboratory of Veterinary Pathology, Tottori University, Tottori, Japan.,The United Graduate School of Veterinary Science, Yamaguchi University, Yamaguchi, Japan
| | - Tomoki Nakamura
- Laboratory of Veterinary Pathology, Tottori University, Tottori, Japan
| | - Yuji Sunden
- Laboratory of Veterinary Pathology, Tottori University, Tottori, Japan
| | - Hajime Miyata
- Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
| | - Takehito Morita
- Laboratory of Veterinary Pathology, Tottori University, Tottori, Japan
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Tomita N, Nakamura T, Sunden Y, Morita T. Histopathological and immunohistochemical analysis of the cerebral white matter after transient hypoglycemia in rat. J Vet Med Sci 2019; 82:68-76. [PMID: 31787662 PMCID: PMC6983658 DOI: 10.1292/jvms.19-0502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Patients with hypoglycemic coma show abnormal signals in the white matter on magnetic resonance imaging. However, the precise pathological changes in the white matter caused by hypoglycemic
coma remain unclear in humans and experimental animals. This study aimed to reveal the distribution and time course of histopathological and immunohistochemical changes occurring in the
white matter during the early stages of hypoglycemic coma in rats. Insulin-induced hypoglycemic coma of 15–30-min duration was induced in rats, followed by recovery using a glucose solution.
Rat brains were collected after 6 and 24 hr and after 3, 5, 7, and 14 days. The brains were submitted for histological and immunohistochemical analysis for neurofilament 200 kDa (NF), myelin
basic protein, olig-2, Iba-1, and glial fibrillary acidic protein (GFAP). Vacuolation was observed in the fiber bundles of the globus pallidus on days 1–14. Most of the vacuoles were located
in GFAP-positive astrocytic processes or the extracellular space and appeared to be edematous. Additionally, myelin pallor and a decrease in NF-positive signals were observed on day 14.
Microgliosis and astrogliosis were also detected. Observations similar to the globus pallidus, except for edema, were noted in the internal capsule. In the corpus callosum, a mild decrease
in NF-positive signals, microgliosis, and astrogliosis were observed. These results suggest that after transient hypoglycemic coma, edema and/or degeneration occurred in the white matter,
especially in the globus pallidus, internal capsule, and corpus callosum in the early stages.
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Affiliation(s)
- Nagi Tomita
- Laboratory of Veterinary Pathology, Tottori University, Tottori, Tottori 680-8553, Japan.,The United Graduate School of Veterinary Science, Yamaguchi University, Yamaguchi, Yamaguchi 753-8511, Japan
| | - Tomoki Nakamura
- Laboratory of Veterinary Pathology, Tottori University, Tottori, Tottori 680-8553, Japan
| | - Yuji Sunden
- Laboratory of Veterinary Pathology, Tottori University, Tottori, Tottori 680-8553, Japan
| | - Takehito Morita
- Laboratory of Veterinary Pathology, Tottori University, Tottori, Tottori 680-8553, Japan
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Saleem Mir M, Maqbool Darzi M, Musadiq Khan H, Ahmad Kamil S, Hassan Sofi A, Ahmad Wani S. Pathomorphological effects of Alloxan induced acute hypoglycaemia in rabbits. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2013.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Masood Saleem Mir
- Division of Veterinary Pathology, F.V.Sc. & A.H. , Sher-e-Kashmir University of Agricultural Sciences and Technology of Kashmir , Shuhama, Alusteng , Kashmir (J&K), 190 006, India
| | - Mohammad Maqbool Darzi
- Division of Veterinary Pathology, F.V.Sc. & A.H. , Sher-e-Kashmir University of Agricultural Sciences and Technology of Kashmir , Shuhama, Alusteng , Kashmir (J&K), 190 006, India
| | - Hilal Musadiq Khan
- MRCSG, F.V.Sc. & A.H, Sher-e-Kashmir University of Agricultural Sciences and Technology of Kashmir , Shuhama, Alusteng , Kashmir (J&K), 190 006, India
| | - Shayaib Ahmad Kamil
- Division of Veterinary Pathology, F.V.Sc. & A.H. , Sher-e-Kashmir University of Agricultural Sciences and Technology of Kashmir , Shuhama, Alusteng , Kashmir (J&K), 190 006, India
| | - Asif Hassan Sofi
- Division of LPT, F.V.Sc. & A.H , Sher-e-Kashmir University of Agricultural Sciences and Technology of Kashmir , Shuhama, Alusteng , Kashmir (J&K), 190 006, India
| | - Sarfraz Ahmad Wani
- Division of LPT, F.V.Sc. & A.H , Sher-e-Kashmir University of Agricultural Sciences and Technology of Kashmir , Shuhama, Alusteng , Kashmir (J&K), 190 006, India
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Morgan RK, Cortes Y, Murphy L. Pathophysiology and aetiology of hypoglycaemic crises. J Small Anim Pract 2018; 59:659-669. [PMID: 30102417 PMCID: PMC7166581 DOI: 10.1111/jsap.12911] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 04/24/2018] [Accepted: 06/15/2018] [Indexed: 01/09/2023]
Abstract
Hypoglycaemia is a common, life-threatening complication that occurs as a component of a wide variety of disease processes. Despite its frequent occurrence, information concerning the aetiology, characteristics and outcomes of hypoglycaemic crises in veterinary medicine is limited. This review summarises the current understanding of the pathophysiology of hypoglycaemia, the body's counter-regulatory response, underlying aetiologies, diagnosis and treatment. Disease mechanisms are discussed and published evidence in veterinary literature regarding prognostic indicators, prevalence, diagnosis and treatment is examined for hypoglycaemia-related disease processes including insulinoma, glucose-lowering toxins and medications.
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Affiliation(s)
- R K Morgan
- Metropolitan Veterinary Associates, Norristown, Pennsylvania, USA
| | - Y Cortes
- Emergency Department, Oradell Animal Hospital, Paramus, New Jersey, USA
| | - L Murphy
- Veterinary Specialty Center of Delaware, New Castle, Delaware, USA
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Katoh M, Yoshino M, Aoki T, Abumiya T, Imamura H, Aida T. Localized reversible high signal intensities on diffusion-weighted MRI in hypoglycemia: A study of 70 cases. Asian J Neurosurg 2016; 11:412-415. [PMID: 27695547 PMCID: PMC4974968 DOI: 10.4103/1793-5482.144196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION It is well-known that localized reversible high signal intensities in the splenium of the corpus callosum or the basal ganglia appear on diffusion-weighted MRI in the presence of hypoglycemia. The aim of this study was to clarify the incidence and significance of such high signal intensity lesions. RESULTS We analyzed 70 cases of hypoglycemia with consciousness disturbance referred to our outpatient office. Localized reversible high signal intensities on diffusion-weighted MRI were noted in 6 cases (8.6%). They were at the splenium of the corpus callosum in four cases (5.7%), and right frontal cortex and bilateral frontal white matter in one each. Convulsions were noted in five cases, and right hemiparesis was noted in three. None of the three cases of hemiparesis showed localized reversible high signal intensities on diffusion-weighted MRI. These lesions are reversible if the patients undergo treatment without delay. CONCLUSION The significance of these lesions is still unclear. However, when a high signal intensity lesion that is not reasonable for the symptom is detected on diffusion-weighted MRI, an immediate check of the blood sugar level is mandatory.
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Affiliation(s)
- Masahito Katoh
- Department of Neurosurgery, Hokkaido Neurosurgical Memorial Hospital, Sapporo, Japan
| | - Masami Yoshino
- Department of Neurosurgery, Hokkaido Neurosurgical Memorial Hospital, Sapporo, Japan
| | - Takeshi Aoki
- Department of Neurosurgery, Hokkaido Neurosurgical Memorial Hospital, Sapporo, Japan
| | - Takeo Abumiya
- Department of Neurosurgery, Hokkaido Neurosurgical Memorial Hospital, Sapporo, Japan
| | - Hiroyuki Imamura
- Department of Neurosurgery, Hokkaido Neurosurgical Memorial Hospital, Sapporo, Japan
| | - Toshimitsu Aida
- Department of Neurosurgery, Hokkaido Neurosurgical Memorial Hospital, Sapporo, Japan
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Yong AW, Morris Z, Shuler K, Smith C, Wardlaw J. Acute symptomatic hypoglycaemia mimicking ischaemic stroke on imaging: a systemic review. BMC Neurol 2012; 12:139. [PMID: 23171315 PMCID: PMC3579722 DOI: 10.1186/1471-2377-12-139] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 11/14/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Acute symptomatic hypoglycaemia is a differential diagnosis in patients presenting with stroke-like neurological impairment, but few textbooks describe the full brain imaging appearances. We systematically reviewed the literature to identify how often hypoglycaemia may mimic ischaemic stroke on imaging, common patterns and relationships with hypoglycaemia severity, duration, clinical outcome and add two new cases. METHODS We searched EMBASE and Medline databases for papers reporting imaging in adults with symptomatic hypoglycaemia. We analysed the clinical presentation, outcome, brain imaging findings, duration and severity of hypoglycaemia, time course of lesion appearance, including two new cases. RESULTS We found 42 papers describing computed tomography or magnetic resonance imaging in 65 patients, plus our two cases with symptomatic hypoglycaemia. Imaging abnormalities on computed tomography and magnetic resonance were uni or bilateral, cortical or sub-cortical. Thirteen (20%) mimicked cortical or lacunar stroke. Acute lesions had restricted diffusion on magnetic resonance or low attenuation on computed tomography, plus swelling; older lesions showed focal atrophy or disappeared, as with ischaemic stroke. The association between the depth or duration of hypoglycaemia, the severity or extent of neurological deficit, and the imaging abnormalities, was weak. CONCLUSION Imaging abnormalities in patients with hypoglycaemia are uncommon but very variable, weakly associated with neurological deficit, and about a fifth mimic acute ischaemic stroke. Blood glucose testing should be routine in all patients with acute neurological impairment and hypoglycaemia should be included in the differential diagnosis of imaging appearances in patients presenting with acute stroke.
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Affiliation(s)
- Ai Wain Yong
- Division of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | - Zoe Morris
- Division of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | - Kirsten Shuler
- Division of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | - Colin Smith
- Department of Neuropathology, Western General Hospital, Edinburgh, UK
| | - Joanna Wardlaw
- Division of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
- Neuroradiology, Bramwell Dott Building, Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh, EH4 2XU, UK
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Independent and symmetric seizures from parasagittal cortex: is this a feature of profound hypoglycemia? Epilepsy Behav 2012; 25:263-5. [PMID: 23041174 DOI: 10.1016/j.yebeh.2012.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 07/17/2012] [Accepted: 07/20/2012] [Indexed: 11/23/2022]
Abstract
Two patients presented with severe hypoglycemia and parasagittal homotopic cerebral hemisphere injury. Days after the initial insult, bilateral, independent, periodic lateralized epileptiform discharges and frequent seizures emerged from the affected homotopic cerebral cortices in both patients. We speculate that synaptic rescaling and increased spontaneous discharges in isolated cerebral cortex may cause epileptogenesis in severe hypoglycemia. Bilateral but temporally independent parasagittal seizures could be a feature of severe hypoglycemia.
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Witsch J, Neugebauer H, Flechsenhar J, Jüttler E. Hypoglycemic encephalopathy: a case series and literature review on outcome determination. J Neurol 2012; 259:2172-81. [PMID: 22491856 DOI: 10.1007/s00415-012-6480-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 02/19/2012] [Accepted: 03/12/2012] [Indexed: 12/16/2022]
Abstract
Data on clinical long-term outcome after the acute phase of hypoglycemic encephalopathy (HE) using validated outcome scales is currently unavailable. Here we report the results of a systematic literature search for studies on HE and data on long-term outcome in patients with HE admitted to three Charité hospitals between January 2005 and July 2010. HE was defined as coma/stupor and blood glucose levels <50 mg/dl on admission, persistence of coma/stupor for ≥24 h despite normalization of blood glucose levels, and exclusion of any other cause of coma/stupor. Outcome was assessed using the modified Rankin scale (mRS), Glasgow Outcome Scale (GOS), and Barthel index (BI). Fifteen patients were included, with a mean age of 60 years (range 29-79). Two were lost to follow-up. Of the remaining 13 patients, six had died (46 %). In the seven survivors, the median mRS score was 0 (range 0-5), median GOS score was 5 (range 2-5), and median BI was 100 (range 0-100). MRIs made in the acute phase were available for three patients and revealed no obvious relation between lesion size or pattern and clinical outcome. To our knowledge, this is the first case series using validated clinical scoring systems to determine clinical long-term outcome after HE. The results suggest that mortality is high, but long-term survival with little or no disability is possible and can be observed in the majority of survivors. Risk of death or poor outcome does not seem to be related to MRI features in the acute phase but rather to other presumably medical factors.
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Affiliation(s)
- Jens Witsch
- Department of Neurology, Charité Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
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Kim E, Sohn CH, Chang KH, Chang HW, Lee D. Patterns of accentuated grey–white differentiation on diffusion-weighted imaging or the apparent diffusion coefficient maps in comatose survivors after global brain injury. Clin Radiol 2011; 66:440-8. [DOI: 10.1016/j.crad.2010.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 12/02/2010] [Accepted: 12/09/2010] [Indexed: 11/15/2022]
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Saji N, Ichiyama T, Tadano M, Shimizu H, Kawarai T, Kita Y, Yokono K. Elderly case of prolonged hypoglycemic coma presenting with reversible magnetic resonance imaging changes. Geriatr Gerontol Int 2010; 10:331-3. [PMID: 20887629 DOI: 10.1111/j.1447-0594.2010.00639.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Tight glycaemic control (TGC) for patients treated in an intensive care unit ICU is associated with an increased risk for hypoglycaemia. Since hypoglycaemia mainly occurs in the sickest patients, no matter whether TGC is applied or not, it might be a marker for severity of illness or a harmful event in itself. Furthermore, it remains a matter of debate whether harmful effects of hypoglycaemia outbalance the clinical benefits of TGC. This review focusses on the clinical manifestations of hypoglycaemia in the critically ill and highlights its potential short- and long-term consequences specifically concerning neurocognitive function.
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Affiliation(s)
- Thomas Duning
- Department of Neurology, University Hospital of Münster, Albert-Schweitzer-Strafle 33, D-48149 Münster, Germany.
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Kang EG, Jeon SJ, Choi SS, Song CJ, Yu IK. Diffusion MR imaging of hypoglycemic encephalopathy. AJNR Am J Neuroradiol 2009; 31:559-64. [PMID: 19875472 DOI: 10.3174/ajnr.a1856] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
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 x 10(-6) mm(2)/s compared with the mean ADC value of noninvolved lesions (837.72 +/- 62.14 x 10(-6) mm(2)/s); this difference was statistically significant (P < .000). The lesions showed complete resolution on follow-up DWI for 6 patients. Three patients with cortical involvement of > or = 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.
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Affiliation(s)
- E G Kang
- Department of Radiology, Wonkwang University Hospital, Chunbuk, Republic of Korea
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Ma JH, Kim YJ, Yoo WJ, Ihn YK, Kim JY, Song HH, Kim BS. MR imaging of hypoglycemic encephalopathy: lesion distribution and prognosis prediction by diffusion-weighted imaging. Neuroradiology 2009; 51:641-9. [PMID: 19533113 DOI: 10.1007/s00234-009-0544-5] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Accepted: 05/29/2009] [Indexed: 11/29/2022]
Affiliation(s)
- Jeong-Hyun Ma
- Department of Radiology, College of Medicine, The Catholic University of Korea, 65-1 Geumo-dong, Uijongbu, Kyunggi-do 480-130, South Korea
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Polito A, Siami S, Sharshar T. Encephalopathy in Sepsis. Intensive Care Med 2009. [DOI: 10.1007/978-0-387-77383-4_74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Per H, Kumandas S, Coskun A, Gümüs H, Oztop D. Neurologic sequelae of neonatal hypoglycemia in Kayseri, Turkey. J Child Neurol 2008; 23:1406-12. [PMID: 19073845 DOI: 10.1177/0883073808319075] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Contrary to belief, neonatal hypoglycemia is relatively common and can cause more severe neurological sequelae than is currently believed. Prevention of hypoglycemic brain damage by hindering prolonged and profound neonatal hypoglycemia might contribute to psychomotor development. At Erciyes University, between December 1996 and 2005, of the patients who applied to Paediatric Neurology Department, 60 cases with a history of neonatal hypoglycemia were included in the study. The magnetic resonance imaging (MRI) scans and clinical records of all patients were reviewed retrospectively. It was noted that the sequelae with glucose levels of 0 0 to 40 were more serious and intense. The same results were also observed in cranial MRI evaluation. In conclusion, intractable epilepsy, mental motor retardation, cerebral palsy, and visual disturbance were found to be the most common and severe conditions affecting sufferers of neonatal hypoglycemia. In the first 3 days of life, the close monitoring of patients at risk is critical, and hospitalization of severe cases should be considered.
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Affiliation(s)
- Hüseyin Per
- Paediatric Neurology, Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey.
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Abstract
Brain dysfunction is a severe complication of sepsis with an incidence ranging from 9% to 71% that is associated with increased morbidity and mortality. Its diagnosis relies mainly on neurologic examination with clinical manifestations ranging from confusion to coma. An electroencephalogram, somatosensory evoked potentials, and measurement of plasma S-100b protein and neuron-specific enolase can be useful for the detection of brain dysfunction. Brain MRI can identify brain lesions such as cerebral infarction, posterior reversible encephalopathy syndrome, and leukoencephalopathy. The mechanism of sepsis-associated encephalopathy involves inflammatory and non-inflammatory processes that affect endothelial cells, glial cells, and neurons and induce blood-brain barrier breakdown, derangements of intracellular metabolism, and cell death. Specific treatments for sepsis-associated encephalopathy need to be developed. Currently, treatment is mainly the management of sepsis.
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Batista MSA, Almeida KJS, Avelino MC, Borges LMV. Hemiparesis and lateralized cortical lesions associated to severe hypoglycemia. ARQUIVOS DE NEURO-PSIQUIATRIA 2008; 66:101-3. [DOI: 10.1590/s0004-282x2008000100027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Saito Y, Ogawa T, Nagaishi JI, Inoue T, Maegaki Y, Ohno K. Laminar cortical necrosis in adrenal crisis: sequential changes on MRI. Brain Dev 2008; 30:77-81. [PMID: 17590301 DOI: 10.1016/j.braindev.2007.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Revised: 04/27/2007] [Accepted: 05/11/2007] [Indexed: 12/18/2022]
Abstract
We describe the serial magnetic resonance imaging (MRI) findings in a six-year-old girl with congenital adrenal hyperplasia, who presented with seizures and unconsciousness during a hypoadrenal crisis. Initial neuroimaging revealed the presence of brain edema with high signal changes in the fronto-parietal cortex on diffusion-weighted MRI. The brain edema worsened four days into admission, and by day 14 low-density areas were seen over the frontal lobes bilaterally using computed tomography (CT). Follow-up MRI at between one and two months of admission revealed extensive white matter lesions with high intensity on T2-weighted images (T2WI) and fluid-attenuated inversion recovery (FLAIR) images, which extended into deep cortical layers. Additionally, linear lesions with high signal change on T1-weighted imaging developed in the superficial cortical layers, with frontal predominance. This layer appeared isointense on T2WI and high intensity on FLAIR images, suggesting laminar cortical necrosis. Two months later, linear, cavitary lesions appeared in the middle cortical layers between the aforementioned superficial laminar abnormality and deep cortex/white matter lesions. The high-intensity signals in the deep cortical layers remained contiguous with the white matter lesions. This unique type of multi-layered cortical lesion may have resulted from a complex combination of hypoglycemia and hypoxia/ischemia in the setting of adrenal insufficiency.
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MESH Headings
- Adrenal Cortex/pathology
- Adrenal Cortex/physiopathology
- Adrenal Hyperplasia, Congenital/complications
- Adrenal Hyperplasia, Congenital/metabolism
- Adrenal Hyperplasia, Congenital/physiopathology
- Adrenal Insufficiency/complications
- Adrenal Insufficiency/metabolism
- Adrenal Insufficiency/physiopathology
- Atrophy/etiology
- Atrophy/pathology
- Atrophy/physiopathology
- Brain Diseases, Metabolic/etiology
- Brain Diseases, Metabolic/pathology
- Brain Diseases, Metabolic/physiopathology
- Brain Infarction/etiology
- Brain Infarction/pathology
- Brain Infarction/physiopathology
- Cerebral Cortex/diagnostic imaging
- Cerebral Cortex/pathology
- Cerebral Cortex/physiopathology
- Child
- Disease Progression
- Female
- Humans
- Hypoglycemia/complications
- Hypoglycemia/pathology
- Hypoglycemia/physiopathology
- Hypoxia-Ischemia, Brain/etiology
- Hypoxia-Ischemia, Brain/pathology
- Hypoxia-Ischemia, Brain/physiopathology
- Magnetic Resonance Imaging
- Necrosis/etiology
- Necrosis/pathology
- Necrosis/physiopathology
- Nerve Fibers, Myelinated/pathology
- Tomography, X-Ray Computed
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Affiliation(s)
- Yoshiaki Saito
- Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago 683-8504, Japan.
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Isolated Cortical Visual Loss With Subtle Brain MRI Abnormalities in a Case of Hypoxic-ischemic Encephalopathy. J Neuroophthalmol 2007; 27:292-6. [DOI: 10.1097/wno.0b013e31815c42b4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wootton-Gorges SL, Glaser NS. Imaging of the brain in children with type I diabetes mellitus. Pediatr Radiol 2007; 37:863-9. [PMID: 17619872 DOI: 10.1007/s00247-007-0536-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Revised: 04/23/2007] [Accepted: 05/15/2007] [Indexed: 11/25/2022]
Abstract
Type 1 diabetes mellitus (DM) affects about 1 in 500 children and can cause damage to multiple organ systems. In recent years, growing attention has been given to the effects of type 1 DM on the brain. In this article we review important imaging features of the brain in children with type 1 DM, including (1) imaging the child in diabetic ketoacidosis and the child with hypoglycemia, (2) syndromes associated with type 1 DM, and (3) long-term effects of type 1 DM on brain structure.
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Affiliation(s)
- Sandra L Wootton-Gorges
- Department of Radiology, UC Davis Children's Hospital, University of California, Davis Medical Center, Sacramento, CA, USA.
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