T2 Weighted Hypointense Subcortical White Matter- A Rare Imaging Feature in Ketotic Hyperglycaemia

Diabetic ketoacidosis is a hyperglycaemic state in which serum glucose level is more than 250 mg/dL, a pH less than 7.3, a serum bicarbonate level less than 18 mEq/L, and serum ketone level is raised and dehydration is present. Insulin deficiency is the main precipitating factor. Rarely, they present with neurological complications such as focal/generalised motor seizures, hemiparesis and sensory deficits which may be associated with various imaging features. With increasing prevalence of diabetes in the last decade, it is vital to familiarise with various hyperglycaemia induced imaging abnormalities in brain in order to provide accurate diagnosis for providing prompt treatment and preventing complications. T2W/FLAIR (Fluid-attenuated inversion recovery) subcortical hypointensity in ketotic patients presenting with focal seizures had been reported rarely. Here, presented are imaging findings of a 27-year-old female patient with newly diagnosed type II diabetes mellitus and diabetic ketoacidosis with new onset seizures. T2 subcortical white matter hypointensity was noted in the right post-central gyrus. Though non specific, this imaging finding was of importance in such cases of hyperglycaemia in order to formulate further patient care.