| Severe hypoglycemia associated with an illegal sexual enhancement product adulterated with glibenclamide: MR imaging findings. | |
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MedLine Citation:
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PMID: 19017925 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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C C Tchoyoson Lim; Robert Gan; Cheng Leng Chan; Alvin W K Tan; Joan J C Khoo; Su-Ynn Chia; Shih Ling Kao; John Abisheganaden; Yih Yian Sitoh |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2008-11-18 |
Journal Detail:
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Title: Radiology Volume: 250 ISSN: 1527-1315 ISO Abbreviation: Radiology Publication Date: 2009 Jan |
Date Detail:
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Created Date: 2008-12-18 Completed Date: 2009-01-06 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0401260 Medline TA: Radiology Country: United States |
Other Details:
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Languages: eng Pagination: 193-201 Citation Subset: AIM; IM |
Copyright Information:
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(c) RSNA, 2008. |
Affiliation:
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Department of Neuroradiology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. tchoyoson_lim@nni.com.sg |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Blood Volume / drug effects Brain / drug effects*, pathology Cerebrovascular Disorders / chemically induced, diagnosis Coma / chemically induced, diagnosis Consciousness Disorders / chemically induced, diagnosis Diffusion Magnetic Resonance Imaging* Dominance, Cerebral / physiology Drug Contamination* Glasgow Coma Scale Glyburide / toxicity* Humans Hypoglycemia / chemically induced*, diagnosis Hypoglycemic Agents / toxicity* Image Processing, Computer-Assisted* Lactic Acid / metabolism Magnetic Resonance Angiography* Magnetic Resonance Spectroscopy* Male Middle Aged Phytotherapy* Piperazines / toxicity* Purines / toxicity Retrospective Studies Seizures / chemically induced, diagnosis Street Drugs / toxicity* Sulfones / toxicity* Vasodilator Agents / toxicity* |
| Chemical | |
Reg. No./Substance:
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0/Hypoglycemic Agents; 0/Piperazines; 0/Purines; 0/Street Drugs; 0/Sulfones; 0/Vasodilator Agents; 10238-21-8/Glyburide; 139755-83-2/sildenafil; 50-21-5/Lactic Acid |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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