Diffusion-weighted imaging (DWI) may detect hyperintense lesions in patients with transient hypoglycaemia-induced hemiparesis or coma, which are completely reversible after glucose infusion.^1–3 In vivo animal studies have documented the visualisation of such hypoglycaemia-induced changes of signal intensity and the reversal by glucose intake in detail.⁴ However, the time necessary for hyperintense lesions on DWI to disappear after glucose infusion in humans is still unclear. We treated a patient in a hypoglycaemic coma with DWI abnormalities in the splenium of the corpus callosum and the bilateral posterior limbs of the internal capsules, which were drastically improved 2 h after glucose infusion.

A 54-year-old woman was taken to an emergency department after being found in an unresponsive state. The patient had had type 2 diabetes mellitus, hypertension and hyperlipidaemia for 7 years, controlled by oral drugs. On arrival, she was comatose (Glasgow Coma Scale 4; E1, V1, M2). Her pupils exhibited isocoria (2 mm/2 mm) and were reactive to light. Tetraparesis and decerebrate rigidity to pain was evident. Her blood pressure was 91/40 mm Hg and her heart rate …