Hypoglycemic Brain Damage
Hypoglycemic brain damage is a different global brain insult from cardiac arrest encephalopathy. We here follow the path of glucose from blood to the brain interstitial space, into the cell, through glycolysis into the Krebs cycle, including the consequent new homeostasis in amino acid metabolism that gives rise to increased aspartic acid within cells. Leakage of aspartate massively floods the extracellular space to kill neurons, while continued turning of a truncated form of the Krebs cycle keeps most brain cells alive. Endogenous substrates are utilized, chiefly phospholipids and fatty acids. The duration of tolerable insult is much longer for hypoglycemia than ischemia, which also releases more glutamate than aspartate into the brain interstitium. The neuropathology in humans is not always distinguishable, but if there is dentate gyrus destruction, a very late event in global ischemia, the distinction of hypoglycemic from ischemic damage can be made. Hypoglycemic brain damage occurs in hospitals, attempted suicide and homicide.
KeywordsHypoglycemia Clinical Experimental Glucose EEG Cortex Hippocampus Electron Microscopy
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