Table 1

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

aSome studies appear more than once if they provided data on patients in more than one category.

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).

CT - computed tomography; MR - magnetic resonance.

Yong et al.

Yong et al. BMC Neurology 2012 12:139   doi:10.1186/1471-2377-12-139

Open Data