Abstracts

Non-ketotic hyperglycemia is often associated with partial seizure. Several explanations of the association have been proposed, but the exact pathomechanism is still unknown. We report two cases of severe non-ketotic hyperglycemia who suffered from non-convulsive status of occipital origin.
At referreal hospital base, we descirbe clinical manifestation and neuroimaing in two patients.
Case 1. A 54-year-old woman with poorly controlled diabetes presented with left side visual abnormality with alteration of consciousness for three days. She complained of visual field defect with multiple moving lights in the left side. On examination, epileptic eyeball deviation and nystagmus to the left side was observed. Laboratory results showed non-ketototic hyperosmolar state. With insulin and phenytoin therapy, visual symptoms and epileptic nystagmus was slowly improved for the following one week. T2-weighted MRI checked on admission day revealed subcortical low signal intensity in right parieto-occipital area with ring-enhancement. Follow-up MRI three month later showed resolution of previous abnormalities.
Case 2. A 42-year-old man presented with recurrent seizure attacks. One week ago, he experienced visual blurring on the left side. Three days later, generalized tonic clonic seizure followed. After then, recurrent abnormal visual sensation on the left side and head turning on the left side occurred. Laboratory results showed non-ketotic hyperosmolar state. T2-weighted MRI showed cortical high signal intensity with relatively low signal on the subcortical white matter. Diffusion weighted image (DWI) showed high signal intensity with low value apparent diffusion coefficient (ADC) value.
Low signal intensity on T2 weighted MRI is rarely reported, and its clinical implication is not clear. Our cases suggest that the MRI abnormality may reflect hyperosmolar state-related change, and the recurrent partial seizures from occipital lobes may be associated with the reversible change on MRI. From the DWI abnormality, it can be inferred that reversible cytotoxic edema is involved in the pathogenesis. Recruitment of more cases and serial study of MRI may be needed to verify the causal relationship of the MRI abnormality and partial seizure in patients with non-ketotic hyperosmolar state.