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Joseph Junewick, MD FACR
over 11 years ago
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Hypoglycemic Encephalopathy

Case Detail

Anatomy: Brain-Spine
Joseph Junewick, MD FACR
Diagnostic Category: Metabolic
Created: over 11 years ago
Updated: over 9 years ago
Tags: PEDS
Modality/Study Types: CT US
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Newborn male with hypoglycemia.

Case Images


Hemorrhagic Periventricular Leukomalacia


CT – Extensive bilateral perilateral ventricular hyperdensity with punctate hyperdensity at the left caudothalamic groove.

US – Deep and subcortical cerebral white matter hyperechogenicity with left thalamic hyperechogenicity.


Glucose is the major energy source in the neonate. Severe or prolonged hypoglycemia can lead to significant neurologic sequelae.

Clinically, infants will show jitteriness, irritability, seizures, and/or apnea. Etiologies include decreased glucose availability, hyperinsulinemia (infant of diabetic mother), endocrine dysfunction, increased glucose utilization (hypothermia, sepsis, asphyxia), and others (congenital heart disease, central nervous system disorders, polycythemia).

Decreased glucose has the same effect on the brain as decrease perfusion or decreased oxygen. Depending upon the length and severity of glucose deprivation, brain abnormalities will be manifest on imaging. In one study, white matter abnormalities are present in 94% of neonates with symptomatic hypoglycemia (WM abnormalities are severe in half of these and about half of these are hemorrhagic).


Burns CM, et al. Patterns of Cerebral Injury and Neurodevelopmental Outcomes. Pediatrics (2008); 122:65-74.

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