Reversible Focal Splenial Lesion on Diffusion–Weighted MRI in Sulfonylurea Intoxication

Neurological findings of hypoglycemia vary from reversible focal deficits to permanent dysfunction or death [1–3]. According to MRI findings, the cerebral cortex, basal ganglion, hippocampus, internal capsule, splenium of corpus callosum (SCC), and cerebral white matter are the most commonly affected sites in hypoglycemic brain injury [2–4]. Hypoglycemic brain injury is usually reversible, and partial recovery or mortality depends on the affected area [2]. Several studies have shown that diffusion-weighted imaging (DWI) may be useful in predicting the prognosis according to the site of involvement [1–4]. Isolated lesion of the SCC in hypoglycemic brain injury are very rare in the literature, but those reported were found to be reversible, both clinically and radiologically [3, 5]. To our knowledge, DWI findings of a reversible lesion of the SCC due to deep hypoglycemia associated with sulfonylurea intoxication has been reported only once in the literature [6]. We present the DWI findings of a reversible SCC lesion due to hypoglycemic brain injury resulting from sulfonylurea intoxication. We also discuss the possible pathogenesis of the lesion and the benefit of using DWI in predicting the clinical outcome.