Imaging features of infants who suffered from brain damage as a result of neonatal hypoglycemia were shown to have similar patterns, and to affect the parietal and occipital lobes most severely. Long term follow up regarding clinical outcome of patients with neonatal hypoglycemia and this pattern of damage are limited. We reviewed the medical records of 24 patients with typical neuroimaging features seen following neonatal hypoglycemia; we report neurological outcome in 13 of them who have documented hypoglycemia. Except for one patient, all patients had prenatal and perinatal problems including prematurity, perinatal hypoxia, intrauterine growth retardation, sepsis, indirect hyperbilirubinemia. All but one patient had symptomatic partial epilepsy, five of them were medically intractable. Other neurologic problems included developmental delays, learning and behavior problems, hyperactivity and attention difficulties, autistic features, microcephaly and cortical blindness. We conclude that early diagnosis and treatment of neonatal hypoglycemia is crucial to prevent future neurological sequelae, especially in patients with additional perinatal risk factors. (c) 2006 Elsevier B.V. All rights reserved.