Neuroradiology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Italy.
IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuroradiologia, Italy.
Neuroradiol J. 2020 Oct;33(5):416-423. doi: 10.1177/1971400920929554. Epub 2020 Jun 15.
We present the neuroimaging findings of three cases of non-ketotic hyperglycaemia (NKH) associated with focal seizures and a review of the previous cases and series reported in literature. NKH is a cause of seizures in both long-standing and newly diagnosed diabetic patients. They are usually focal motor seizures, rarely with a secondary generalisation. This condition does not fully respond to anticonvulsant therapy if glycaemic levels are not normalised. Of interest, magnetic resonance imaging (MRI) of NKH could be different from those observed during other kinds of seizures. Indeed, seizure-related MRI abnormalities mainly involve the cortical grey matter, while NKH-related seizures usually appear as reversible subcortical T2/fluid attenuation inversion recovery (FLAIR) hypointensity. This latter abnormality shows a good spatial correlation with the area of the ictal focus on electroencephalogram and could be associated with other more common post-ictal MRI changes (cortical grey matter T2/FLAIR hyperintensity, cortical or leptomeningeal enhancement). Although these abnormalities tend to be transient, a focal volume loss or gliosis can result on follow-up imaging. Our cases confirm T2/FLAIR subcortical hypointensity as a main neuroradiological hallmark of NKH-induced seizures.
我们呈现了三例非酮症高血糖（NKH）相关局灶性癫痫发作的神经影像学发现，并对文献中以前报道的病例和系列进行了回顾。NKH 是长期和新诊断的糖尿病患者癫痫发作的一个原因。它们通常是局灶性运动性癫痫发作，很少继发全面性发作。如果血糖水平未正常化，这种情况对抗癫痫药物治疗的反应不完全。有趣的是，NKH 的磁共振成像（MRI）可能与其他类型的癫痫发作观察到的不同。事实上，与癫痫相关的 MRI 异常主要涉及皮质灰质，而 NKH 相关的癫痫发作通常表现为可逆的皮质下 T2/液体衰减反转恢复（FLAIR）信号强度降低。这种异常与脑电图上的癫痫发作灶区域具有良好的空间相关性，并且可能与其他更常见的癫痫后 MRI 改变相关（皮质灰质 T2/FLAIR 高信号、皮质或软脑膜增强）。尽管这些异常往往是短暂的，但在随访成像上可能会出现局灶性体积损失或胶质增生。我们的病例证实 T2/FLAIR 皮质下信号强度降低是 NKH 引起的癫痫发作的主要神经影像学标志。
