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Sequelae following hypoglycemic coma are rare, dependent on the severity and duration of hypoglycemia, and include profound memory loss, persistent vegetative state, and death in 2 to 4% of cases. MRI reports are limited and characterized by lesions that involve cerebral cortex, hippocampus, and basal ganglia.1-3⇓⇓ Diffusion-weighted MRI (DWI) detects change in water diffusion with cellular dysfunction and primarily identifies early ischemic changes in stroke.4 We here report DWI in association with hypoglycemic coma and consider its prognostic importance.
Case history.
A 53-year-old man with insulin-dependent diabetes mellitus and HIV infection was taken to the Hartford Hospital emergency department after being found unresponsive at home. A friend found the patient “sleeping” and gave him his morning insulin dose; when he failed to awaken after several hours, emergency medical services was called. On arrival they found the patient unresponsive with pinpoint pupils, shallow respirations, and hypotension. Blood glucose was 23 mg/dL and the patient was given 1 mg of glucagon and 1.4 mg of naloxone hydrochloride IM without improvement. Medical …
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