Journal List > Endocrinol Metab > v.27(2) > 1085946

Kim and Park: Visual Seizure: A Reversible Complication of Non-Ketotic Hyperglycemia

Abstract

A 65-year-old man with diabetes mellitus was presented with left visual aura, followed by a versive seizure, each lasting approximately 3 minutes. Neurological examination showed an intermittent left homonymous hemianopsia. Brain magnetic resonance imaging (MRI) showed right occipital lobe lesion, with cytotoxic edema. Blood glucose was 593 mg/dL and serum osmolarity was 309 mOsm/kg. The seizures were controlled by normalization of blood sugar and short-term anticonvulsant, and the lesions were resolved in a follow-up MRI. We report a case of visual seizures associated with non-ketotic hyperglycemia.

Figures and Tables

Fig. 1
Brain magnetic resonance imaging obtained at the 7th day after the symptoms onset. T2-weighted (A) and fluid attenuated inversion recovery image (B) show right occipital cortical hyperintensities and subcortical hypointensities and diffusion-weighted image (C) and apparent diffusion coefficient (D) demonstrate restricted D diffusion.
enm-27-155-g001
Fig. 2
Follow-up brain magnetic resonance imaging obtained at the 39th day after the onset of symptoms. Fluid attenuated inversion recovery image (A), diffusion-weighted image (B) and apparent diffusion coefficient (C) show resolution of previous abnormal signal intensity lesion.
enm-27-155-g002

References

1. Maccario M. Neurological dysfunction associated with nonketotic hyperglycemia. Arch Neurol. 1968. 19:525–534.
2. Harden CL, Rosenbaum DH, Daras M. Hyperglycemia presenting with occipital seizures. Epilepsia. 1991. 32:215–220.
3. Rector WG Jr, Herlong HF, Moses H 3rd. Nonketotic hyperglycemia appearing as choreoathetosis or ballism. Arch Intern Med. 1982. 142:154–155.
4. Maccario M, Messis CP, Vastola EF. Focal seizures as a manifestation of hyperglycemia without ketoacidosis. A report of seven cases with review of the literature. Neurology. 1965. 15:195–206.
5. Cochin JP, Hannequin D, Delangre T, Guegan-Massardier E, Augustin P. Continuous partial epilepsy disclosing diabetes mellitus. Rev Neurol (Paris). 1994. 150:239–241.
6. Lee SH, Shin JA, Kim JH, Son JW, Lee KW, Ko SH, Yang SH, Son BC, Ahn YB. Chorea-ballism associated with nonketotic hyperglycaemia or diabetic ketoacidosis: characteristics of 25 patients in Korea. Diabetes Res Clin Pract. 2011. 93:e80–e83.
7. Lavin PJ. Hyperglycemic hemianopia: a reversible complication of non-ketotic hyperglycemia. Neurology. 2005. 65:616–619.
8. Tiamkao S, Pratipanawatr T, Nitinavakarn B, Chotmongkol V, Jitpimolmard S. Seizures in nonketotic hyperglycaemia. Seizure. 2003. 12:409–410.
9. Osborn AG, Salzman KL, Barkovich AJ. Diagnostic imaging: brain. 2009. 2nd ed. Salt Lake City: Amirsys;I-4-109–I-4-113.
10. Sabitha KM, Girija AS, Vargese KS. Seizures in hyperglycemic patients. J Assoc Physicians India. 2001. 49:723–726.
11. Raghavendra S, Ashalatha R, Thomas SV, Kesavadas C. Focal neuronal loss, reversible subcortical focal T2 hypointensity in seizures with a nonketotic hyperglycemic hyperosmolar state. Neuroradiology. 2007. 49:299–305.
12. Moien-Afshari F, Téllez-Zenteno JF. Occipital seizures induced by hyperglycemia: a case report and review of literature. Seizure. 2009. 18:382–385.
13. Lammouchi T, Zoghlami F, Ben Slamia L, Grira M, Harzallah MS, Benammou S. Epileptic seizures in non-ketotic hyperglycemia. Neurophysiol Clin. 2004. 34:183–187.
14. Tiamkao S, Janon C, Sawanyawisuth K, Pratipanawatr T, Jitpimolmard S. Prediction of seizure control in non-ketotic hyperglycemic induced seizures. BMC Neurol. 2009. 9:61.
TOOLS
Similar articles