Late Cerebral Changes Incident to Severe Hypoglycemia (Insulin Shock)

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Abstract
The fact that acute severe degrees of hypoglycemia may result in symptoms referable to the brain and that in event of fatal issue such symptoms are accompanied by structural changes in the central nervous tissues has been recognized for some years. The resulting cerebral (rarely cerebellar) lesions were at first considered to be a consequence of the toxic effect of insulin. This conclusion did not seem illogical at the time, for in cases with short survival period the alterations in the gray matter were not particularly specific. As time has gone on, however, the recognition of the total pathological picture of severe insulin shock proves the lesion complexes to be remarkably similar to, if not identical with, those of cerebral anoxia of various etiologies. The kaleidoscopic picture of cerebral anoxia has come to be fairly well defined.1-6With some relatively minor differences in the end-picture due to variations in

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