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AJNR - American Journal of Neuroradiology

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Reversible Reduction of Apparent Diffusion Coefficient Values in Bilateral Internal Capsules in Transient Hypoglycemia–Induced Hemiparesis

S. Albayram^a, H. Ozer^a, S. Gokdemir^b, F. Gulsen^a, G. Kiziltan^b, N. Kocer^a and C. Islak^a

^a Department of Neuroradiology, Cerrahpasa Medical School, Istanbul, Turkey
^b Department of Neurology, Cerrahpasa Medical School, Istanbul, Turkey

View larger version (45K): [in a new window]   Fig 1. A–C, Axial T2 (TR/TE, 3500/111 ms; number of excitations, 2) diffusion-weighted MR images (b = 1000 s/mm2; TE, 97; gradient strength, 24mT/m) and ADC map are interpreted as normal at this time.

View larger version (66K): [in a new window]   Fig 2. MR imaging was performed at 12:00 AM on August 13; glucose level was 32 mg/dL at 11:00 AM. MR imaging was performed when the patient had hemiparesis. T2-weighted MR imaging (TR/TE, 5810/116 ms; number of excitations, 2) (A) shows suspected hyperintensities within the bilateral internal capsule. Diffusion-weighted imaging (B) (b = 1000 s/mm2; TE, 110; gradient strength, 24 mT/m) shows the presence of hyperintense lesions within the bilateral internal capsule. ADC values (C) calculated this time for the left internal capsule are 0.43 min/0.47 max/0.44 avg 10–3 mm2/s and, for the right internal capsule, are 0.50 min/0.55 max/0.52 avg 10–3 mm2/s.

View larger version (67K): [in a new window]   Fig 3. MR imaging was performed at 7:00 PM on August 13; glucose level was 80 mg/dL at 6:00 PM. The patient’s hemiparesis improved immediately after the glucose infusion, and she recovered completely within hours without neurologic deficit. T2-weighted MR image (TR/TE, 4000/116 ms; number of excitations, 2) (A) shows no signal intensity changes. Diffusion-weighted MR image (b = 1000 s/mm2; TE, 113; gradient strength, 24 mT/m) (B) after recovery shows prominent regression of hyperintense lesions within the bilateral internal capsule, and ADC values (C) for the left internal capsule are 0.61 min0.73 max/0.65 avg 10–3 mm2/s and, for the right internal capsule, are 0.64 min/0.70 max/0.60 avg 10–3 mm2/s.