Table 5

Neuroimaging patterns in hypoglycaemic and hyperglycaemic and hyponatraemic and hypernatraemic encephalopathy

Hypoglycaemic encephalopathy
 CTEnhancing, hypodense basal ganglia, cerebral cortex, hippocampus and substantia nigra
  • ▸ T2 and FLAIR hyperintensities in the caudate, lenticular nuclei, cerebral cortex, substantia nigra, hippocampus and internal capsules

  • ▸ In few patients DWI hyperintense white and deep grey matter and splenium of the corpus callosum

Hyperglycaemic encephalopathy
 CTHyperdense putamen and/or caudate nucleus
 MRIUnilateral or bilateral T1 hyperintensities in the striatum (mostly putamen)
 SPECTHypoperfusion of the basal ganglia
Hyponatraemic/hypernatraemic encephalopathies (pontine or extrapontine myelinolysis)
  • ▸ Normal in a few patients and hypodense pontine lesions in the others

  • ▸ T2, FLAIR and DWI hyperintense lesions of the pons. Less frequent lesions of the thalamus, midbrain, cortical grey matter, hippocampus, caudate, putamen and middle cerebral peduncle

  • ▸ T2 hyperintensities may be distributed along the crowns and sides of the cerebral gyri

 SPECTDecreased striatal dopamine transporter binding and pontine hyperperfusion during recovery
  • DWI, diffusion-weighted imaging; FLAIR, fluid-attenuated inversion recovery; SPECT, single-photon emission CT.