Lateralization of hypoglycemic encephalopathy: evidence of a mechanism of selective vulnerability

Background: One of the characteristics of hypoglycemic encephalopathy (HE) is selective vulnerability of different brain regions.

Case report: We observed a patient with unilateral HE affecting the right internal capsule and the subcortical white matter. The patient had a preexisting stroke in the opposite hemisphere. The hemisphere that was affected by HE exhibited greater regional blood flow (single positron-emission tomography) and higher fractional anisotropy (diffusion-tensor imaging) than the unaffected hemisphere.

Conclusions: This case suggests that the degree of metabolism required to maintain the function of brain structures and neuronal integrity is an important factor determining the selective vulnerability in HE.