Bilateral Basal Ganglia Lesions
A 41-year-old woman with a history of insulin-dependent diabetes mellitus was found unresponsive and with a blood glucose level of 15 mg/dL. She was using an implanted insulin pump for diabetic control. The patient lives alone and had no contact with any other individuals for 14 hours before she was found. Neurologic examination revealed a poor level of responsiveness to verbal and tactile stimuli, but intact brainstem reflexes. Limb responses were absent except for slight left leg withdrawal to touch. She had bilateral extensor plantar responses. MRI of the head is shown in the Figure.


(Enlarge Image)

Noncontrast fast spin-echo fluid-attenuated inversion-recovery (FLAIR, top row) and postcontrast T1-weighted gadolinium (T1-gad, bottom row) brain MRI 1.5-T scans.

True or false: The lesions involve the globus pallidus.

1. 
   True
   
2. 
   False
   

View the correct answer.

<p>False</p>


True or false: The lesions involve the thalamus.

1. 
   True
   
2. 
   False
   

View the correct answer.

<p>False</p>


True or false: The lesions involve the caudate.

1. 
   True
   
2. 
   False
   

View the correct answer.

<p>True</p>


True or false: The lesions involve the internal capsule.

1. 
   True
   
2. 
   False
   

View the correct answer.

<p>False</p>


True or false: The lesions involve the putamen.

1. 
   True
   
2. 
   False
   

View the correct answer.

<p>True</p>


True or false: The lesions are hemorrhagic.

1. 
   True
   
2. 
   False
   

View the correct answer.

<p>False</p>


True or false: The lesions enhance.

1. 
   True
   
2. 
   False
   

View the correct answer.

<p>False</p>


The most likely diagnosis is brain injury due to:

1. 
   Hypoglycemia
   
2. 
   Carbon monoxide poisoning
   
3. 
   Wernicke encephalopathy
   
4. 
   Strokes
   
5. 
   Metastatic disease
   

View the correct answer.

<p>Hypoglycemia</p>