Is fluid-attenuated inversion recovery MRI more sensitive than conventional MRI for hypoglycemic brain injury?

Hypoglycemia after insulin treatment may be difficult to diagnose.1 Neurologic signs are nonspecific and include confusion, weakness, seizures, and coma that may lead to death.1 We report lesions of the caudate and putamen that were shown better by fluid-attenuated inversion recovery (FLAIR) than T2-weighted imaging (T2WI) in the subacute phase of probable hypoglycemic brain injury. A 41-year-old nurse with diabetes mellitus who had been using an insulin pump (MiniMed Inc., Sylmar, CA) for 6 months was found at home 3 days after she was last seen. Blood pressure was 174/112 mm Hg, pulse was 130, and respiratory rate was 40. She was comatose with spontaneous extensor posturing and intact pupillary, corneal, and oculocephalic responses. Blood glucose was 300 mg/dL in the field and 230 mg/dL on admission. The cartridge of the patient’s insulin pump was empty and showed three repeated deliveries of 6.7 units of insulin over 20 minutes 2 days previously. It was unknown if the insulin delivery was accidental, due to pump malfunction, or a suicide attempt. Results of toxicology screens were negative. CT revealed vague hypodensities of the caudate and anterior putamen bilaterally …