Diagnostic dilemma in non-ketotic Hyperglycemic seizures on mr imaging

Acute metabolic encephalopathy is potentially a reversible condition and requires an early diagnosis and management to reduce morbidity and mortality, as in under diagnosed patients, permanent damage can result. Diabetic encephalopathy is an emerging complication of both type I and type II diabetes. Besides T1 hperintensities in bilateral basal ganglia in diabetic encephalopathy patients, reported in most of the literature reviewed, patients with hyperglycemic seizures can present with subcortical hyperintensities , with predilection for occipital lobes. Here, we report a case of type II diabetic, 40 year-female patient who was referred for MR brain to our department, presented with acute symptoms of delirium, headache and fits, increased serum glucose levels at time of presentation. No T1 hyperintensities were identified in basal ganglia, instead the variable pattern of subcortical hyperintensities were identified with postcontrast patchy and gyriform enhancement. She was diagnosed with metabolic encephalopathy and referred back to referring clinician for adequate management. On follow up, patient improved clinically with insulin therapy. This report highlights the importance of early diagnosis of diabetic encephalopathy in patients with variable patterns on MR imaging , thus to avoid unnecessary medical treatment and prevent irreversible symptoms