Lateralization of hypoglycemic encephalopathy: evidence of a mechanism of selective vulnerability

BackgroundzzOne of the characteristics of hypoglycemic encephalopathy (HE) is selective vulnerability of different brain regions. Case ReportzzWe observed a patient with unilateral HE affecting the right internal capsule and the subcortical white matter. The patient had a preexisting stroke in the opposite hemisphere. The hemisphere that was affected by HE exhibited greater regional blood flow (single positron-emission tomography) and higher fractional anisotropy (diffusion-tensor imaging) than the unaffected hemisphere. ConclusionszzThis case suggests that the degree of metabolism required to maintain the function of brain structures and neuronal integrity is an important factor determining the selective vulnerability in HE. J Clin Neurol 2010;6:104-108