Xiang Xiao-Hui, Fang Jia-Jia, Yang Mi, Zhao Guo-Hua
Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China.
World J Clin Cases. 2021 Mar 6;9(7):1720-1727. doi: 10.12998/wjcc.v9.i7.1720.
Nonketotic hyperglycemia (NKH) is characterized by hyperglycemia with little or no ketoacidosis. Diverse neurological symptoms have been described in NKH patients, including choreoathetosis, hemiballismus, seizures, and coma in severe cases. Homonymous hemianopia, with or without occipital seizures, caused by hyperglycemia is less readily recognized.
We describe a 54-year-old man with NKH, who reported seeing round, colored flickering lights with right homonymous hemianopia. Cranial magnetic resonance imaging demonstrated abnormalities in the left occipital lobe, with decreased T2 signal of the white matter, restricted diffusion, and corresponding low signal intensity in the apparent diffusion coefficient map. He responded to rehydration and a low-dose insulin regimen, with improvements of his visual field defect.
Patients with NKH may present focal neurologic signs. Hyperglycemia should be taken into consideration when making an etiologic diagnosis of homonymous hemianopia.
非酮症高血糖症（NKH）的特征是血糖升高且几乎没有或没有酮症酸中毒。NKH患者出现了多种神经症状，包括舞蹈手足徐动症、偏身投掷症、癫痫发作，严重时可出现昏迷。由高血糖引起的同侧偏盲，无论有无枕叶癫痫发作，都较难识别。
我们描述了一名54岁的NKH男性患者，他报告称在同侧偏盲的右侧视野看到圆形、彩色闪烁的灯光。头颅磁共振成像显示左侧枕叶异常，白质T2信号降低，弥散受限，在表观扩散系数图上相应区域呈低信号强度。他通过补液和小剂量胰岛素治疗方案后，视野缺损有所改善。
NKH患者可能出现局灶性神经体征。在对同侧偏盲进行病因诊断时，应考虑高血糖因素。
