A case of severe hypoglycemic encephalopathy

Abstract

Hypoglycemic encephalopathy is a metabolic encephalopathy that usually occurs in diabetic patients and is due to low levels of blood glucose in the body. The clinical presentation varies in severity from mild cases presenting with fatigue, sweating and poor concentration to severe cases leading to stupor, coma and death. Diagnosis is often delayed due to inadequate recognition of the cause and diverse clinical picture. Imaging studies show characteristic changes in the cerebral cortex and deep grey nuclei. Management is mainly supportive. We present here a case of a seventy five year old diabetic who was found lying unresponsive at home in the morning and was brought to the emergency. She was found to have very low levels of blood glucose which were corrected with no improvement in the sensorium. She was ventilated and treated with glucose infusions and supportive care. MRI scans of the brain showed features of extensive hypoglycemic encephalopathy with damage of the parietal and occipital cortices and also deep gray nuclei including thalami bilaterally. She had no change in clinical status after a prolonged hospital stay and succumbed to secondary infection. Prolonged hypoglycemia leads to widespread neuronal damage through energy failure and apoptosis. This leads to prolonged coma and even death in severe cases. This case report is meant to stress the importance of early diagnosis and treatment in the long term outcome of hypoglycemic encephalopathy.1. Hypoglycemic encephalopathy is an important clinical entity with a wide variety of clinical presentations; 2. We present here a case of a seventy five year old diabetic with a prolonged duration of hypoglycemia and severe hypoglycemic encephalopathy who had a poor outcome; 3. Early diagnosis and treatment are essential for good long term outcomes.