Multi-modal brain imaging showing brain damage to the orbitofrontal cortex and left hemisphere, in a case of prolonged hypoglycemia-induced transient hemiplegia followed by persistent encephalopathy

Authors

  • Shinsuke Koike MD, PhD,

    Corresponding author
    1. Department of Neuropsychiatry, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
    • Department of Psychiatry, Tokyo Metropolitan Bokuto Hospital, Tokyo, Japan
    Search for more papers by this author
  • Ryuichi Sasaki MD

    1. Department of Psychiatry, Tokyo Metropolitan Bokuto Hospital, Tokyo, Japan
    2. Onai Hospital, Saitama, Japan
    Search for more papers by this author

Correspondence: Shinsuke Koike, MD, PhD, Department of Neuropsychiatry, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. Email: skoike-tky@umin.ac.jp

Abstract

A 21-year-old left-handed male patient was admitted with a 19-h history of coma after substantial insulin injection for suicide attempt. Although the patient recovered from coma 3 days after injury, he experienced transient hemiplegia followed by permanent brain damage. Electroencephalogram (EEG), brain magnetic resonance imaging (MRI), and brain single-photon emission computed tomography (SPECT) identified the localization of this dysfunction, but consistency between clinical symptoms and brain images changed depending on the course of treatment. Transient hemiplegia corresponded to abnormal waveforms on EEG and decreased cerebral blood flow on SPECT, whereas persistent dysfunctions corresponded to abnormal brain regions on MRI and SPECT.

Ancillary