老年人低血糖脑病的临床及神经影像学特征

Clinical and neuroimaging features of hypoglycemia encephalopathy in the elderly

目的探讨老年人低血糖脑病的临床及神经影像学特点。方法对36例低血糖伴神经系统表现的患者进行病史回顾、临床分析及颅脑CT和MRI检查。结果36例低血糖患者11例发现颅脑MRI典型的双侧尾状核和豆状核对称性异常信号，而脑CT相应部位未见明显异常，病前27例有感染、发热等诱因，临床表现多种多样。低血糖脑病的发生以老年糖尿病患者口服或注射降糖药者居多。随访6个月，神经影像学无明显好转。结论低血糖脑病临床表现多不典型，对意识障碍的患者，要注意低血糖反应。颅脑CT对低血糖脑病的诊断价值不大，颅脑MRI对重症患者的诊断具有重要价值，特征性的磁共振表现预示着病情危重，且预后不良。

Objective To investigate the clinical and neuroimaging features of hypoglycemia encephalopathy in the elderly. Methods The history and clinical features of 36 patients who had undergone brain CT and MRI were analyzed retrospectively. Results Twenty-seven patients had infections and fevers as a trigger, presenting all kinds of symptoms. Eleven cases were found to have abnormal signals in bilateral caudate nucleus and lenticular nucleus in MRI. But CT examination showed no new lesions in corresponding position. Hypoglycemia encephalopathy were commanly found in the elderly who had diabetes mellitus and treated with drugs. After being followed up for 6 months, their neuroimaging did not change. Conclusions Because the patients often present unconsciousness and weakness with a sudden onset, hypoglycemia is easily mistaken for other disorders, especially in the elderly. For those with consciousness, we should pay more attations to hypoglycemia. Brain CT has no value of diagnosing hypoglycemia encephalopathy, while MRI plays an impotant role in diagnosing the disease. The characteristic MRI features predicts a bad prognosis.