Neonatal Hypoglycaemic Encephalopathy

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Figure 1. Figure 1: MRI of the brain in a neonate.

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Patient history

History: 8-day-old preterm female neonate presenting with poor feeding and seizures for 3 days. Blood glucose levels within 48 hours of admission were –15, 10, 15, 12, 10, 15 and 20 mg/dl.

Imaging findings — key points

• Neonatal hypoglycaemic encephalopathy is a metabolic brain injury of the newborn.
• Preterm infants and infants of diabetic mothers are at particular risk.
• Presentation may include poor feeding and seizures.
• Hypoglycaemia is documented by serial blood glucose measurement.
• MRI is the imaging modality of choice for assessment.
• Hypoxic-ischaemic injury and PRES are important differential considerations.

Discussion

This case illustrates neonatal hypoglycaemic encephalopathy, a metabolic brain injury occurring in the newborn period, with preterm infants among those at risk. The clinical picture of poor feeding and seizures over 3 days, together with serial blood glucose levels as low as –15 mg/dl, prompted MRI. The imaging diagnosis was neonatal hypoglycaemic encephalopathy, and the case analysis also raised hypoxic-ischaemic injury and posterior reversible encephalopathy syndrome (PRES) as considerations. The teaching value lies in recognising hypoglycaemia as a cause of neonatal encephalopathy and in distinguishing it from hypoxic-ischaemic injury and PRES. Pitfalls include attributing seizures solely to a structural or epileptic cause without checking glucose. Management implication: prompt recognition and correction of hypoglycaemia are essential to limit brain injury.

Differential diagnosis

The confirmed diagnosis itself is not included as an alternative — it is stated separately below.

See all Neuroradiology differential diagnoses