SHM Converge Scientific Abstract ePoster Gallery-Case of Mistaken Identity: Hyperglycemia Mimicking Intraparenchymal Hemorrhage

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This case highlights a diagnostic pitfall in patients with severe hyperglycemia and altered mental status. A 62-year-old woman with type 2 diabetes and hypertension presented with confusion, abdominal tenderness, marked leukocytosis, and profound hyperglycemia (glucose 531 mg/dL, HbA1c 16.3%). Because her mental status worsened, a stroke evaluation was initiated. Initial head CT showed a 2.4 cm hyperdensity in the right basal ganglia, interpreted as possible intraparenchymal hemorrhage, along with bilateral basal ganglia calcifications. She was also found to have a pelvic abscess, which required antibiotics and surgical debridement.<br /><br />Before any intervention for presumed hemorrhagic stroke, MRI of the brain was obtained two days later. It demonstrated T1 hyperintensity in the bilateral lentiform nuclei, greater on the right, matching the CT abnormality but not consistent with acute hemorrhage. A follow-up CT three weeks later showed complete resolution of the hyperdensity. Her mental status returned to baseline after treatment of the infection and improved glycemic control.<br /><br />The case underscores that hyperglycemia can mimic intracerebral hemorrhage on neuroimaging, particularly in the basal ganglia. Recognizing this mimic is crucial because management differs significantly: stroke treatment and cerebral edema from hyperglycemia require different approaches, and unnecessary surgical or invasive interventions can be avoided with prompt MRI confirmation. Clinicians should be aware of this rare but important imaging pattern and consider hyperglycemia in the differential diagnosis of basal ganglia hyperdensity.

Asset Subtitle

Prekchha Jha

Meta Tag

Author List Bijay Thapa, Omar Jameel, Prekchha Jha

Category Clinical Vignettes

Concept Severe Hyperglycemia

Concept Neurologic Symptoms

Concept Imaging abnormalities

Concept Intracranial Hemorrhage

Concept Computed Tomography

Distinguished Non-Finalist

Presenter Organization Corewell Health William Beaumont University Hospital, Royal Oak, MI

Presenting Author Prekchha Jha

Track Adult

Keywords

hyperglycemia

altered mental status

basal ganglia hyperdensity

intracerebral hemorrhage mimic

type 2 diabetes

MRI brain

T1 hyperintensity

stroke evaluation

basal ganglia calcifications

pelvic abscess

Severe Hyperglycemia

Neurologic Symptoms

Imaging abnormalities

Intracranial Hemorrhage

Computed Tomography