A male neonate born at 36 weeks weighing 2.165 kg presented with seizures at 20 days of age. Perinatal history included episodes of hypoglycemia as low as 31 mg/dL, corrected by oral glucose administration. Multiple developmental anomalies were diagnosed prenatally, including bilateral aural atresia and duodenal web.

Brain magnetic resonance imaging (MRI) was performed for evaluation of seizures, showing acute injury in the parietal and occipital lobes, suggestive of hypoglycemic brain injury ([Fig. 1]). MRI also showed an ectopic posterior pituitary gland ([Fig. 2]). Endocrine testing indicated low cortisol but no additional hormonal deficits.

A transient reduction in blood glucose can be normal following birth and resolves within the first 48 to 72 hours of life. When severe and prolonged, hypoglycemia typically results in excitotoxic cerebral damage.[1]

Although the topography of brain injury seen in neonatal hypoglycemia is not entirely understood, relatively symmetric occipital and posterior parietal lobe involvement is the main feature seen from birth up to 6 months of age. In older infants, basal ganglia damage and parieto-temporal cortex involvement are more common.

Early recognition and intervention are imperative in preventing neurological damage in neonates with hypoglycemia.[1] MRI depicts the extent of brain injury and may identify congenital anomalies of the hypothalamic–pituitary apparatus as a potential cause.[2]