235 Proton Mr Spectroscopy (1H-Mrs), Diffusion Weighted Imaging (DWI) and Ultrasonography (US) in Neonatal Hypoglycaemia: A Case Report

Introduction: several neuropathological studies have documented brain damage following hypoglycaemia. In a few cases damage has been reported in vivo using CT, MRI and US. Here we report a functional and anatomic study of the brain in a case of transient symptomatic hypoglycaemia.Case report: term newborn, AS 9–10, LGA, of a non-diabetic primigravida was referred to NICU at 51 hrs of age due to hypoglycaemia (12 mg/dl); a bolus of 200 mg/kg followed by an infusion of 5 mg/kg/min of e.v. glucose was administered and blood glucose reached a normal value (> 40 mg/dl). Clinical and electric seizures were diagnosed on arrival in NICU and continued for 24 hrs despite glycemic normalisation and phenobarbital treatment. HIE, other metabolic diseases and meningoencephalitis were excluded. At age 3 days cranial US showed a patchy hyperecogenicity of the periventricular and subcortical white matter at the parieto-occipital level; ventricles were split-like. Lesions were confirmed by MRI and resolved at about one month of age without developing ventriculomegaly. The infant underwent 1H-MRS and DWI at 4, 11, 17 and 31 days after birth. N-acethyl aspartate/Creatine (NAA/Cr) reduction and severe lactate and lipid accumulation were present in the occipital cortex; adjusted diffusion coefficient in the occipital lobes was severely reduced (-50%) at first examination and progressively recovered at all later time points. Clinical follow-up at 4 years of age is normal.Discussion: For the first time by combining 1H-MRS, DWI and traditional imaging we have detected severe, transient, occipital lobe metabolic abnormalities in a hypoglycaemic neonate with a normal outcome at 4 years of age. US and MR were able to first detect these lesions and may be a good initial study in the hypoglycaemic neonate.