Abstracts

Rationale: We report a 48-year-old right-handed female, who was seeing floating balloons, chairs, people and clouds across the right visual field every four minutes for 25 days, presenting after a generalized tonic-clonic seizure. Methods: Video-EEG telemetry, brain imaging and lumbar puncture were performed and she was followed for one year. Results: Her serum glucose was 40mmol/L with negative ketones. Video-EEG telemetry indicated multifocal left hemispheric seizures (Figure 2a-c) in the occipital, temporal and frontal regions. MRI of brain indicated T2 hyperintensities in the left medial occipital, medial temporal and lateral temporal regions extending into the insular cortex. The same areas also diffusion restrict with no contrast enhancement (Figure 1). Cerebrospinalfluid had increased glucose, mild increase in protein and normal cells. She received insulin infusion, levetiracetam and lacosamide and became seizure-free after adequate glycemic control and MRI brain changes normalized. Conclusions: The occurrence of multifocal left hemispheric seizures as well as generalized tonic-clonic seizure in the setting of non-ketotic hyperglycemia is unique. In nonketotic hyperglycemia, GABA shunt lowers the threshold for seizure, however, it does not explain the focal seizures. KATP channels, which are variably present in different parts of the brain may lead to focal depolarization and seizures during hyperglycemia. Funding: No funding was received in support of this abstract