HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text All Versions of this Article: 2493080795v1 250/1/193    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Lim, C. C. T. Articles by Sitoh, Y. Y. PubMed PubMed Citation Articles by Lim, C. C. T. Articles by Sitoh, Y. Y.

Severe Hypoglycemia Associated with an Illegal Sexual Enhancement Product Adulterated with Glibenclamide: MR Imaging Findings¹

¹ From the Departments of Neuroradiology (C.C.T.L., Y.Y.S.) and Neurology (R.G.), National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433; Department of Pharmacovigilance, Centre for Drug Administration, Health Sciences Authority, Singapore (C.L.C.); Departments of Endocrinology (A.W.K.T.) and Respiratory Medicine (J.A.), Tan Tock Seng Hospital, Singapore; Department of Endocrinology, Changi General Hospital, Singapore (J.J.C.K.); Department of Endocrinology, Singapore General Hospital, Singapore (S.Y.C.); Department of Endocrinology, National University Hospital, Singapore (S.L.K.); and Department of Diagnostic Imaging, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (C.C.T.L.). Received May 6, 2008; revision requested June 17; revision received June 20; accepted July 3; final version accepted July 15. Supported in part by the Singapore Radiological Society Trust Fund. Address correspondence to C.C.T.L. (e-mail: tchoyoson_lim{at}nni.com.sg).

Purpose: To describe the magnetic resonance (MR) imaging findings associated with severe hypoglycemia after consumption of an illegal sexual enhancement product (Power 1 Walnut) adulterated with glibenclamide, an oral hypoglycemic agent used to treat diabetes mellitus.

Materials and Methods: Institutional review board approval was obtained for this retrospective study. Records in eight male patients with severe hypoglycemia of unknown cause, without prior treatment for diabetes, and with positive blood toxicology results for glibenclamide were reviewed. MR imaging included diffusion-weighted imaging and, in some patients, MR angiography, dynamic contrast material–enhanced perfusion MR imaging, and MR spectroscopy.

Results: In seven patients, there were hyperintense abnormalities on diffusion-weighted and T2-weighted images in the hippocampus and cerebral cortex, sparing the subcortical white matter and cerebellum. Three patients had abnormalities of the splenium of the corpus callosum, and one had widespread involvement, including the caudate nucleus, basal ganglia, and internal capsule bilaterally. In three patients, unilateral cortical involvement, which did not conform to the typical cerebral arterial territories, was noted. In one patient, perfusion MR imaging showed slightly increased relative cerebral blood volume, and MR spectroscopy revealed no evidence of abnormal lactate in the affected cerebral cortex.

Conclusion: Diffusion-weighted MR imaging findings in patients with severe hypoglycemia showed typical lesions in the hippocampus and cerebral cortex, but the caudate nucleus and basal ganglia were involved in only the most severely affected patient. The splenium of the corpus callosum and internal capsule were also abnormal in three patients, and unilateral cortical lesions could be distinguished from acute ischemic stroke by the pattern of involvement and MR angiographic, perfusion, and spectroscopic findings.

© RSNA, 2008