Cerebral cortical laminar necrosis on diffusion‐weighted MRI in hypoglycaemic encephalopathy

Background  Laminar necrosis of the cerebral cortex characterized neuropathologically by delayed selective neuronal necrosis occurs in hypoglycaemic encephalopathy and other brain diseases. Case report  A 37‐year‐old male with insulin‐treated Type 1 diabetes mellitus developed hypoglycaemic encephalopathy associated with respiratory failure. Brain diffusion‐weighted MRI during the subacute period demonstrated high signals along the cerebral cortex. Brain single‐photon emission computed tomography showed diffuse, severe cerebral hypoperfusion. The patient remained comatose and died 1 month later. Conclusions  High signals along the cortical bands on diffusion‐weighted MRI suggest cortical laminar necrosis, although a postmortem examination was unavailable. Sustained hypoglycaemic brain injury, possibly associated with respiratory hypoxia, may be the underlying mechanism.