Found down, non-responsive, and hypoglycemic. There is extensive diffuse bilateral symmetric cerebral cortex restricted diffusion and T2 hyperintensity, with a posterior predominance. There is also restricted diffusion and high T2 signal in the bilateral posterior limbs of the internal capsules and to a lesser extent in the anterior left putamen. There is mild diffuse cerebral volume loss. There is a punctate focus of susceptibility effect in the anterior left frontal lobe, which may represent a chronic microhemorrhage. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst.
Extensive cytotoxic edema involving the cortex of the bilateral cerebral hemispheres, with a posterior predominance, bilateral posterior limbs of the internal capsules, and to a lesser extent the left putamen. The constellation of findings and clinical setting are most compatible with acute hypoglycemic encephalopathy.