Clinical features:
(1) history of severe hypoglycemia, often repeated
(2) altered level of consciousness
(3) cognitive deficit including amnesia
(4) seizures
(5) focal neurologic deficits
(6) respiratory failure
Findings on imaging studies::
(1) extensive bilateral hyperintense lesions in the cerebral cortex, basal ganglia and grey matter on diffusion-weighted MRI
Pathology:
(1) laminar necrosis throughout the cerebral cortex
(2) loss of myelin and axons in the cerebral white matter with reactive astocytosis
Complications:
(1) prolonged coma
(2) permanent disability
Differential diagnosis:
(1) vascular dementia
(2) hypoxic encephalopathy
(3) posterior reversible encephalopathy
(4) other causes of encephalopathy
