 Hello everyone, this is Dr. Rishi Ruporkar. I'm a third year radiologist resident from Tobiwala National Medical College and Tobiwala National Medical Hospital, Mumbai. Today, we'll talk about toll of MRI in acute hypoglycemic brain injury. The brain relies heavily on glucose of optimal functioning because the neurons have a high metabolic rate and can neither generate nor store significant amounts of glucose. Increased plasma glucose can jeopardize normal neuronal homeostasis over a period of minutes. Relatively stable plasma glucose levels are therefore essential for survival and are maintained through a highly complex network of enzymes, hormones, and signaling mechanisms with insulin playing a dominant role. Acute hypoglycemic brain injury can cause major morbidity and significant mortality. It is associated with DM type 2 being more common than type 1. It encompasses diabetic ketosis, hypoglycemic hyperosmolar state, hypoglycemia-induced hemicorea hemipalaceanus. Lab investigations, they show raised plasma glucose levels and raised serum HB1C. Ketoneemia and ketoneuria are seen in diabetic ketosis. However, they are absent or minimal in the other two states. The first case we have, a 56-year-old female who presented to us with blurring of vision and irritability since one month. She was a known case of type 2 DM. On examination, the motor examinations have been normal, higher mental functions have been normal. Kinelegal examination, it showed decreased vision and bilateral eyes, rest of the clinical levels have been normal. Sensory system investigation was normal. Other system examinations were unremarkable. Lab investigations we saw serum glucose was raised, HB1C was raised, blood and urine ketones were absent. Rest of the lab work was unremarkable. NCCT brain showed no significant abnormality on MRI. We saw restricted diffusion on DWI-IDC, subtle T2 flare hyperintensive and subtle booming on FFE images involving the white matter of left parietal and occipital lobe. The second case we have, a 43-year-old male who was a known case of diabetes type 2, presented with certain onset focal seizures and loss of consciousness for a brief period. On examination, the motor examination was normal, higher mental functions, the patient was lethargic. Kinelegal examination was normal, sensory and other systemic examination were normal and unremarkable. Lab investigation we saw random RBS was raised, HB1C was raised, blood and urine ketones were positive. The patient had hyponetrium and hypochillinia. The serum bicarbonates were low. And rest of the work was unremarkable. So basically the patient was in diabetic ketoneosis. MRI, excel sections of MRI brain showed an ill-defined area of T2 flare hyperintensity instead of cortical white matter involving the right parietal region with multifocal patchy areas of diffusion restriction involving the overlying gray matter. The third case we have as a 58-year-old female was not a known case of any major illnesses who presented to us with certain onset development of continuous non-rhythmic involuntary movements involving left half of body, that is hemibalasmas and hemicorrhea since one week, the symptoms they resolved during sleep. On examination, the left upper and lower extremity, hemibalasmas and hemicorrhea like movements were seen, higher mental functions, gradient of examination, sensory system examination and general examination were normal. We saw raised RBS, NHB1C as lab investigation, the blood and urine ketones were negative and rest of the lab work was unremarkable. On NCCT brain, we saw a hyperdensity in the right lentiform nucleus. On MRI brain, we saw hyperintensity signal on T1 with pulse contrast enhancement in right lentiform nucleus, no signal alteration on T2 flare, no blooming on FFE and no restriction diffusion on BWYN ADC. To conclude, hyperglycemia is not uncommon and can show myriad of imaging findings. The presentation is often non-specific and objective findings of HCHB memory loss, hemiparesis and often coma clinically moving stroke. In acute settings, these patients invariably undergo an NCCT of the head initially. It may be occasionally useful, but it's often non-dognistic, particularly in case of HSS. MR imaging is a study of choice in these cases and is often used to determine diagnosis and prognosis. A timely and accurate diagnosis could expedite correct treatment and limit neuronal injury in the early stage when changes are potentially impossible. Thank you.