The Clinical Presentations and Prognosis of Non-Ketotic Hyperglycemia Induced Seizure

BACKGROUND: Seizure can be triggered by the non-ketotic hyperglycemia (NKH). Recently we analysed 18 cases of NKH induced seizure to identify the causes for NKH, seizure types, prognosis, and the differences of clinical presentation between the patient with chronic brain structural lesion (CBSL) and the patient without. METHODS: Eighteen patients with NKH induced seizure were selected from the database. Data regarding brain images, clinical symptoms, co-morbid illnesses, blood laboratories, and prognosis were collected. Patients were divided into two groups according to the presence of CBSL. RESULTS: The patients with CBSL showed more generalized tonic-clonic seizure (GTCS) than without. Focal seizures in this group appeared to be originated from the pre-existing lesion in many situations. The poor compliance to anti-diabetic treatment and physical stresses were most common causes for NKH. One year seizure remission without anti-epileptic drug treatment was achieved in 17 of 18 patients. CONCLUSIONS: The patients with CBSL might have more GTCS than without. The impairment of inhibitory mechanism surrounding the focal irritative zone might be one of plausible explanation for this phenomenon. The prognosis was favorable. Further large studies are required.

Clinical analysis of non-ketotic hyperglycemia chorea / 中国神经精神疾病杂志

Objective To investigate the clinical manifestation,neuroimaging characteristics and follow-up results of chorea associated with non-ketotic hyperglycemia (C-H-BG).Methods Clinical data of six patients with C-H-BG were analyzed retrospectively.Results The average age of the six patients (five female and one male) was 65.8±13.9 years,All patients had acute-subacute course.Patients presented with choreic movements involving facial muscles (n=6) and unilateral (n=5) or bilateral limbs (n=1).The average value of plasma glucose at admission was 9.21 ± 5.15 mmol/L.All patients had significantly elevated HbA1c (14.1 ±3.5％).The brain MRI T1 imaging from all patients showed hyperintensity in the basal ganglia,putamen,lenticular nucleus and caudate nucleus.SWI imaging revealed corresponding hypointensity signal in the basal ganglia in three patients.Two patients had severe stenosis of the MCA.Five patients were followed up for an average of 16.2 ±7.2 months.Three patients died.Conclusion The high T1 hypertense lesions in the basal ganglia are the mainly radiological feature of C-H-BG which may be accompanied by SWI hytointense signals in the basal ganglia.

Clinical analysis of non-ketotic hyperglycemia chorea / 中国神经精神疾病杂志

Objective To investigate the clinical manifestation,neuroimaging characteristics and follow-up results of chorea associated with non-ketotic hyperglycemia (C-H-BG).Methods Clinical data of six patients with C-H-BG were analyzed retrospectively.Results The average age of the six patients (five female and one male) was 65.8±13.9 years,All patients had acute-subacute course.Patients presented with choreic movements involving facial muscles (n=6) and unilateral (n=5) or bilateral limbs (n=1).The average value of plasma glucose at admission was 9.21 ± 5.15 mmol/L.All patients had significantly elevated HbA1c (14.1 ±3.5％).The brain MRI T1 imaging from all patients showed hyperintensity in the basal ganglia,putamen,lenticular nucleus and caudate nucleus.SWI imaging revealed corresponding hypointensity signal in the basal ganglia in three patients.Two patients had severe stenosis of the MCA.Five patients were followed up for an average of 16.2 ±7.2 months.Three patients died.Conclusion The high T1 hypertense lesions in the basal ganglia are the mainly radiological feature of C-H-BG which may be accompanied by SWI hytointense signals in the basal ganglia.

Clinical characteristics of hemichorea associated with non-ketotic hyperglycemia in 3 patients: case report and literature review / 中南大学学报(医学版)

Objective:To investigate the pathophysiology,clinical manifestation and neuroimaging characteristics and therapeutic experiences for hemichore associated with non-ketotic hyperglycemia (HC-NH).Methods:Clinical data of three patients with HC-NH from Xiangya Hospital,Central South University were analyzed retrospectively,and the related literature was reviewed.Results:The core clinical features of HC-NH were characterized by acute/subacute onset of hemichorea with non-ketotic hyperglycemia in the elderly females.Radiologic findings associated with HC-NH were characterized by hyperattenuation on computed tomographic (CT) scans and hyperintensity on Tl-weighted magnetic resonance imaging (MRI) at unilateral basal ganglion region.Blood glucose control was the foundation of treatment.Dopamine receptor antagonists and benzodiazepine sedative were helpful in controlling hemichorea.Conclusion:Hemichorea-hemiballismus is a rare complication of nonketotic hyperglycaemia in elderly type 2 diabetes.It is associated with contralateral striatal radiological abnormality and typically T1 hyperintensity on MRI.The pathophysiology of HC-NH is not clear.The prognosis of HC-NH is favorable.Antidiabetic drugs combined with dopamine receptor antagonists can effectively relieve the hemichorea symptoms.

Aphasic Seizure as a Manifestation of Non-Ketotic Hyperglycemia

Non-ketotic hyperglycemia (NKH) is often related to various types of epileptic seizures. However, aphasic seizures associated with NKH have been rarely reported. A 60-year-old diabetic woman was admitted with language disturbance. She presented recurrent motor aphasia and EEG demonstrated ictal rhythmic discharges initiated from left frontal lobe. The seizures disappeared after introduction of carbamazepine and successful control of serum glucose. She remained seizure-free for three months after discharge. We report a case of NKH, manifested by aphasic seizures.

Occipital Lobe Simple Partial Epilepsy Presenting as Visual Episodes Associated with Non-Ketotic Hyperglycemia / 대한간질학회지

Non-ketotic hyperglycemia (NKH) is recognized both as a direct cause of a precipitating factor of many types of epileptic seizure, including simple partial motor, complex partial as well as reflex motor seizure, choreoathetosis and ballismus. Its association with isolated visual alteration is less known. A 74-year-old diabetic woman with visual complaints manifested as flashing colorful lights (red, yellow and blue) in both visual field with progressive increase in frequency. Among the laboratory tests, NKH of 508mg/dL stood out. Slow waves from the right occipital region maximum at O2 associated with visual symptom were recorded in EEG. Brain MRI showed subcortical T2WI and FLAIR hypointensities in the right occipital lobe with scanty enhancement. Patient was treated with hydration and insulin and her symptoms disappeared after hyperglycemia was corrected. We stress that isolated visual episodes may be initial manifestation of occipital lobe simple partial seizure associated with NKH.

Non-convulsive Complex Partial Status Epilepticus as a Manifestation of Non-Ketotic Hyperglycemia

Status complex partial seizure caused by non-ketotic hyperglycemia (NKH) has been known to be rare. A 42-year-old diabetic man was admitted because of abnormal behavior. Video-EEG monitoring revealed an ictal EEG correlate of this behavior. Brain MRI showed an abnormal signal intensity in the right temporal cortex. Seizures were controlled by lowering glucose levels and a follow-up MRI showed resolution of the abnormal signal. We report a case of non-convulsive status epilepticus as a complex partial seizure type by NKH.

Non-ketotic Hyperglycemia Manifested as Occipital Lobe Complex Partial Status Epileticus

A 48-year-old woman presented with right visual aura evolving into versive and clonic seizures. The seizures were controlled not by anticonvulsants but bynormalization of blood sugar and not by anticonvulsants. T2-weighted MRI (T2WI) showed subcortical hypointensity and cortical hyperintensity with a low apparent diffusion coefficient (ADC) value in left occipital area, which reversed into a high ADC value at in follow-up images. Serial MRIs including diffu-sion- weighted images seemed to reveal tissue injury after partial status epilepticus and regional ischemia associated with non-ketotic hyperglycemia.

Hemichorea Associated with Hyperglycemia: A Case Showing Increased Blood Flow in the Contralateral Striatum

We report a diabetic woman who developed paroxysmal hemichorea during an episode of non-ketotic hyper-glycemia. A MRI showed a high signal intensity on T1-weighted images and a low signal intensity on T2-weighted images in the contralateral putamen. SPECT on the 30th day after the onset revealed an increased blood flow in the contralateral striatum. Although these abnormalities in the left putamen are considered to be the cause of her involuntary movement, the exact pathophysiological mechanisms of these abnormalities are not yet clear and further investigations are needed.