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Hypoglycemic Encephalopathy


Presentation

  • Old infarcts were also present in the bilateral occipital lobes.[ncbi.nlm.nih.gov]
  • A 72-year-old woman presented with poor appetite and was initially drowsy at home; the symptoms progressed to loss of consciousness accompanied by mild incontinence.[ncbi.nlm.nih.gov]
  • […] disorders, sleep disorders, and others Major categories of systemic illness are explored for each presentation to guide you towards a likely cause.[books.google.com]
  • […] to the diagnosis) April 12, 2017 POLPSA (posterior labrocapsular periosteal sleeve avulsion) April 11, 2017 presentation2 September 11, 2015 presentation September 11, 2015 pleomorphic xenthoastrocytoma September 11, 2015 Copyright 2015, Radiology.[radiologywisdom.com]
  • The present findings suggest that emperipolesis can occur even in chronic metabolic disorders that extensively involve the cerebral white matter.[ncbi.nlm.nih.gov]
Precocious Puberty
  • Gonadal neoplasms occur in about 10 of both boys and girls diagnosed with precocious puberty. The most common cause of precocity from gonadal estrogen production in girls is a follicular cyst.[europeanmedical.info]
Infertility
  • Females Males Last Updated on Sun, 16 Sep 2018 Infertility Peripheral precocity can be caused by a number of disorders. A careful history will eliminate rare iatrogenic causes such as hormone containing lotions or meat from animals fed steroids.[europeanmedical.info]
Failure to Thrive
  • Fred Ferri’s popular "5 books in 1" format provides quick guidance on menorrhagia, Failure to Thrive (FTT), Cogan’s syndrome, and much more.[books.google.com]
Gagging
  • On physical exam, patient was found to have PPG (with cycle lasting about 3-5 seconds, she was breathing spontaneously over the vent, and had a positive gag reflex.[neurology.org]
Cryptorchidism
  • Cryptorchidism refers to a developmental condition in which one or both testicles fail to descend into the scrotum. Many will descend normally in the first few months of life.[europeanmedical.info]
Stupor
  • HE was defined as coma/stupor and blood glucose levels 50 mg/dl on admission, persistence of coma/stupor for 24 h despite normalization of blood glucose levels, and exclusion of any other cause of coma/stupor.[ncbi.nlm.nih.gov]
  • Discussion Though there is no consensus regarding clinical definition of this term, Jens Witsch et al. in their series defined this entity as a clinical state leading to stupor or coma with the blood glucose level of The exact pathophysiology of hepatic[ijcasereportsandimages.com]
  • HE was defined as coma/stupor and blood glucose levels Keywords Hypoglycemia Hypoglycemic encephalopathy Clinical outcome Magnetic resonance imaging This is a preview of subscription content, log in to check access.[link.springer.com]
  • Further reading [ edit ] The Diagnosis of Stupor and Coma by Plum and Posner, ISBN 0-19-513898-8, remains one of the best detailed observational references to the condition. External links [ edit ][en.wikipedia.org]
  • […] tremors; occasionally, coma or death) Anoxic encephalopathy (wide range of complications, from none in short-term anoxia to personality changes, severe brain damage to death in long-term anoxic events) Uremic encephalopathy (lethargy, hallucinations, stupor[rxlist.com]
Altered Mental Status
  • Initial DWI was performed during which each patient showed altered mental status that was attributed to profound hypoglycemia.[ncbi.nlm.nih.gov]
  • […] doi: 10.1097/NRL.0b013e3181a6ec56 Clinical Report Abstract Author Information Authors Article Metrics Metrics Hypoglycemia is a frequently encountered cause of altered mental status in clinical practice.[journals.lww.com]
  • Hypotension ( low blood pressure ) due to many factors (for example, bleeding , major infection, or blood pressure medications) may result in encephalopathy with symptoms of fainting , weakness, and altered mental status.[emedicinehealth.com]
  • O Variety of symptoms – headache, altered mental status, visual disturbances, and seizures. O Hypertension, Pre-eclampsia/eclampsia, immunosuppression, sepsis, chemotherapy, collagen vascular disease, and renal failure. 13.[slideshare.net]
  • Often, symptoms of altered mental status can present as inattentiveness, poor judgment, or poor coordination of movements.[rxlist.com]
Dysarthria
  • Upon regaining consciousness he exhibited severe dysarthria and several interhemispheric disconnection signs such as intermanual conflict, left-hand dysgraphia, left hemispatial neglect confined to the right hand, impaired interhemispheric transfer, and[ncbi.nlm.nih.gov]
  • After four weeks of treatment he started responding and recognizing family members with severe hypo kinetic dysarthria and generalized rigidity. Repeat MRI of brain after four weeks showed resolution of all previous lesions.[ijcasereportsandimages.com]
  • Arginase deficiency: This autosomal recessive disorder presents with e pisodes of hyperammonemia associated with history of recurrent vomiting, episodes of ataxia, headache and dysarthria.[neuroweb.us]
  • Other neurological signs may include dysarthria, hypomimia, problems with movements (they can be clumsy or slow), ataxia, tremor. [2] Other neurological signs may include involuntary grasping and sucking motions, nystagmus (rapid, involuntary eye movement[en.wikipedia.org]
Amnesia
  • Bilateral hippocampal damage causes Korsakoff's amnesia. This is a memory disorder characterized by inability to retain new information (anterograde amnesia) and a less severe defect of recall of old memories (retrograde amnesia).[neuropathology-web.org]
  • Focal neurological deficits are less common. [3] Wernicke encephalopathy can co-occur with Korsakoff alcoholic syndrome, characterized by amnestic-confabulatory syndrome: retrograde amnesia, anterograde amnesia, confabulations (invented memories), poor[en.wikipedia.org]
  • O A 52-year-old woman presented with low- grade fever, headache, disorientation, amnesia, bad response to communication, numbness in the right hand, blurred vision in the right eye and tonic-clonic seizures in the previous two weeks.[slideshare.net]
Agitated Delirium
  • The individual findings that cause a clinician to refer to a person as having encephalopathy include intellectual disability, irritability, agitation, delirium, confusion, somnolence, stupor, coma and psychosis.[en.wikipedia.org]

Workup

Generalized Slow Activities
  • EEG showed generalized slow activity. On physical exam, patient was found to have PPG (with cycle lasting about 3-5 seconds, she was breathing spontaneously over the vent, and had a positive gag reflex.[neurology.org]

Treatment

  • (Department of Endocrinology,The People's Hospital of Jiangyan City,Jiangsu 225500,China) Objective To sum up the experience in diagnosis and treatment of hypoglycemic encephalopathy.Methods Clinical data of 50 cases of hypoglycemia encephalopathy were[en.cnki.com.cn]
  • It is hoped that increased awareness of the importance of early diagnosis and treatment of these disorders may result in a lowering of the incidence of structural changes and morbidity.[books.google.de]
  • In severe cases, an injection of glucagon (a hormone with the opposite effects of insulin) or an intravenous infusion of dextrose is used for treatment, but usually only if the person is unconscious. Q.[medical-dictionary.thefreedictionary.com]
  • Signal characteristics T1 : low signal T2 : high signal DWI : can be an earlier and sensitive tool showing reversible diffusion restriction 6 Treatment and prognosis The clinical outcome has a direct relation with the severity and duration of the hypoglycemic[radiopaedia.org]
  • Treatment is usually surgical, and if malignant, adjuvant therapy may be indicated. Hepatoblastomas and hepatomas usually present with bilateral testicular enlargement and have a...[europeanmedical.info]

Prognosis

  • Key Words: diffusion weighted imaging ; hypoglycemia ; prognosis[kjccm.org]
  • The prognosis depends on the degree of hypoglycemia, duration, and condition of the organism. Due to the long duration of hypoglycemia, unfortunately, the patient died. It is critical to diagnose hypoglycemic encephalopathy as early as possible.[ncbi.nlm.nih.gov]
  • AIMS: The aim of this study was to investigate factors predicting poor prognosis in patients with hypoglycemic encephalopathy. METHODS: We retrospectively analyzed data on 165 consecutive patients with hypoglycemic encephalopathy.[ncbi.nlm.nih.gov]
  • Diffusion-Weighted MR Imaging in Early Diagnosis and Prognosis of Hypoglycemia, L. Loa AJNR.[neuroradiologycases.com]
  • Signal characteristics T1 : low signal T2 : high signal DWI : can be an earlier and sensitive tool showing reversible diffusion restriction 6 Treatment and prognosis The clinical outcome has a direct relation with the severity and duration of the hypoglycemic[radiopaedia.org]

Etiology

  • Etiology Any cause of profound hypoglycemia 4 : overdose of hypoglycemic medication (usually in diabetics) pancreatic insulinoma As hypoglycemia is usually recognised and managed promptly, MRI scans are not routinely performed unless there is a complicated[radiopaedia.org]
  • [10] Akinetic-rigid syndrome implies difficulty in initiating movements (bradykinesia or akinesia), rigidity, progressive fatiguing, slow mentation (bradyphrenia) with or without tremor at rest and postural instability. [11] It is caused by diverse etiology[ijcasereportsandimages.com]
  • Clinical hypoglycemia has diverse etiologies. Severe hypoglycemia eventually lead to glucose deprivation of the central nervous system resulting in hunger; sweating; paresthesia; impaired mental function; seizures; coma; and even death.[icd10data.com]
  • When referring to a disease, encephalopathy refers to a wide variety of brain disorders with very different etiologies, prognoses and implications.[en.wikipedia.org]

Pathophysiology

  • The pathophysiology is uncertain, but altered cellular physiology results in neuronal death 4-5,7 . It is known that hypoglycemia leads to a cellular energy failure, as the brain is an obligate glucose metabolizer.[radiopaedia.org]
  • Pathophysiological mechanisms responsible for neuronal cell death in hypoglycemia include the involvement of glutamate excitotoxicity.[ncbi.nlm.nih.gov]
  • Discussion Though there is no consensus regarding clinical definition of this term, Jens Witsch et al. in their series defined this entity as a clinical state leading to stupor or coma with the blood glucose level of The exact pathophysiology of hepatic[ijcasereportsandimages.com]
  • In this article, the author has described the definition, physiology, pathophysiology, clinical features, imaging abnormalities, and management of hypoglycemia.[medlink.com]

Prevention

  • Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets[books.google.com]
  • […] to undergo peripheral blood glucose detection to avoid misdiagnosis and mistreatment.We must further emphasize the guide for diet and medication,and employ intensive glycemic control for patients with diabetes mellitus,especially for older people,to prevent[en.cnki.com.cn]
  • Can encephalopathy be prevented? Many cases of encephalopathy can be prevented. The key to prevention is to stop or limit the chance of developing any of the multitudes of causes of encephalopathy.[rxlist.com]
  • Thiamine before glucose to prevent Wernicke encephalopathy: examining the conventional wisdom. JAMA. 1998 Feb 25;279(8):583-4.[lifeinthefastlane.com]

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