Brain Magnetic Resonance Imaging of Neonatal Hypoglycemia: Assessing Injury Extent and Potential Cause

A male neonate born at 36 weeks weighing 2.165 kg presented with seizures at 20 days of age. Perinatal history included episodes of hypoglycemia as low as 31 mg/dL, corrected by oral glucose administration. Multiple developmental anomalies were diagnosed prenatally, including bilateral aural atresia and duodenal web.

Brain magnetic resonance imaging (MRI) was performed for evaluation of seizures, showing acute injury in the parietal and occipital lobes, suggestive of hypoglycemic brain injury ([Fig. 1]). MRI also showed an ectopic posterior pituitary gland ([Fig. 2]). Endocrine testing indicated low cortisol but no additional hormonal deficits.

Fig. 1 Axial diffusion-weighted images (top row) and corresponding apparent diffusion coefficient maps (bottom row) show diffusion restriction relatively symmetrically involving the bilateral parietal, occipital, and posterior temporal lobes and also the posterior corpus callosum and the posterior limbs of the internal capsules. The dorsal thalami are minimally involved. Findings reflect acute parenchymal injury.

Fig. 2 Sagittal T1-weighted image through the midline shows ectopic T1 hyperintense signal of the neurohypophysis, which is located along the third ventricular floor posterior to the optic chiasm. The pituitary stalk is very thin, and the adenohypophysis is subjectively small for age.

A transient reduction in blood glucose can be normal following birth and resolves within the first 48 to 72 hours of life. When severe and prolonged, hypoglycemia typically results in excitotoxic cerebral damage.[1]

Although the topography of brain injury seen in neonatal hypoglycemia is not entirely understood, relatively symmetric occipital and posterior parietal lobe involvement is the main feature seen from birth up to 6 months of age. In older infants, basal ganglia damage and parieto-temporal cortex involvement are more common.

Early recognition and intervention are imperative in preventing neurological damage in neonates with hypoglycemia.[1] MRI depicts the extent of brain injury and may identify congenital anomalies of the hypothalamic–pituitary apparatus as a potential cause.[2]

Statement of Work Location

This manuscript was compiled at the Stanford University School of Medicine, Department of Radiology by all three authors.

Publication History

Received: 02 July 2024

Accepted: 24 July 2024

Article published online:
12 August 2024

• References

• 1 De Angelis LC, Brigati G, Polleri G. et al. Neonatal hypoglycemia and brain vulnerability. Front Endocrinol (Lausanne) 2021; 12: 634305
• 2 Jagtap VS, Acharya SV, Sarathi V. et al. Ectopic posterior pituitary and stalk abnormality predicts severity and coexisting hormone deficiencies in patients with congenital growth hormone deficiency. Pituitary 2012; 15 (02) 243-250