Diffuse Cortical, Basal Ganglia, and Bilateral Middle Cerebellar Peduncle Diffusion Restriction in Severe Alcohol-Related Hypoglycemic Encephalopathy: A Case Report

Alcohol-induced hypoglycemia is an uncommon but potentially life-threatening metabolic complication, particularly in the setting of prolonged fasting and chronic alcohol use. We report the case of a 63-year-old man with a history of alcoholism who presented in a deep coma after binge drinking and reduced oral intake. On admission, severe hypoglycemia (30 mg/dL) was documented, prompting urgent metabolic correction and neuroimaging evaluation. Brain magnetic resonance imaging (MRI) subsequently demonstrated diffuse cortical diffusion restriction with additional involvement of the neostriatum, posterior limbs of the internal capsules, and bilateral middle cerebellar peduncles, consistent with severe hypoglycemic encephalopathy. Despite prompt glucose correction and supportive management, the patient failed to recover neurologically, remained in a persistent disorder of consciousness, and ultimately died during hospitalization. This report aims to illustrate the characteristic radiological pattern and poor clinical outcome associated with alcohol-related hypoglycemic encephalopathy. This case highlights the potential for alcohol-related hypoglycemia to produce widespread cytotoxic brain injury and underscores the prognostic significance of diffuse cortical involvement on early diffusion-weighted imaging (DWI), emphasizing the importance of early recognition for prognostic assessment and clinical management.