Profound hypoglycemia presents with reversible symmetrical ADC signal changes isolated to eloquent cortex of the parietal lobe.

MRI diffusion/ADC signal change with reversal, symmetrically isolated to the cortex of the precentral gyri in profound hypoglycemia has not been previously described. We present a case in which minimal cortical signal change without deep gray matter involvement and subsequent reversal occurred without significant clinical improvement. Correlation of the reversal of diffusion/ADC signal to findings by EEG evaluation has been described in animal studies and not in humans before.