Nissa Zebun, Siddiqi Shaista A, Abdool Sharifa A M
Department of Neurology, Rashid Hospital, Dubai, United Arab Emirates.
Epilepsy Behav Case Rep. 2016 May 10;6:3-5. doi: 10.1016/j.ebcr.2016.04.008. eCollection 2016.
Nonketotic hyperglycemia (NKH) is known to cause focal motor or secondarily generalized seizures. Occipital seizures in NKH are seldom reported, especially with visual hallucinations and persistent homonymous hemianopia (HH) with characteristic radiological and electroencephalographic (EEG) findings.
Our patient was a middle-aged man who presented with a new onset, single episode of generalized tonic-clonic seizure and NKH. He complained of seeing intermittent colorful stripes in his right visual field. Examination revealed persistent complete right HH and he was observed to have complex partial seizures. Magnetic resonance imaging (MRI) showed subcortical T2 hypointensity within the left occipital lobe in T2W and FLAIR images. The EEG showed electrographic seizures originating from the left occipital region. Random blood glucose at presentation was 581 mg/dl with HbA1c of 11.4%. The seizure and visual field deficits were successfully terminated by the introduction of antiseizure medication and glycemic control.
Occipital seizures with visual field deficits can occur in hyperglycemic states. These can be associated with specific MRI brain and EEG changes. The HH is reversible with apt treatment primarily including glycemic control with or without antiseizure medication.
已知非酮症高血糖（NKH）可引起局灶性运动性发作或继发性全身性发作。NKH患者枕叶癫痫发作的报道很少，尤其是伴有视幻觉和持续性同向性偏盲（HH）且具有特征性影像学和脑电图（EEG）表现的情况。
我们的患者是一名中年男性，出现新发单次全身性强直阵挛发作及NKH。他主诉右侧视野间歇性出现彩色条纹。检查发现持续性完全性右侧HH，且观察到他有复杂部分性发作。磁共振成像（MRI）在T2加权像和液体衰减反转恢复序列（FLAIR）图像上显示左侧枕叶皮质下T2低信号。脑电图显示起源于左侧枕叶区域的脑电图发作。就诊时随机血糖为581mg/dl，糖化血红蛋白（HbA1c）为11.4%。通过使用抗癫痫药物和控制血糖，癫痫发作和视野缺损成功得到控制。
高血糖状态下可发生伴有视野缺损的枕叶癫痫发作。这些发作可能与特定的脑部MRI和脑电图改变有关。通过适当治疗，主要包括使用或不使用抗癫痫药物控制血糖，HH是可逆的。
