Shiraishi Wataru, Inamori Yukiko, Nakazawa Yusuke, Shii Hirofumi
Department of Neurology, Kokura Memorial Hospital, Kitakyushu, JPN.
Department of Internal Medicine, Shiraishi Internal Medicine Clinic, Nogata, JPN.
Cureus. 2024 Jul 22;16(7):e65102. doi: 10.7759/cureus.65102. eCollection 2024 Jul.
Hyperglycemia sometimes initially presents with neurological manifestations, including seizures, visual hallucinations, choreoathetosis, hemiballismus, myoclonus, tremor, and consciousness disturbance. Epileptic seizures induced by hyperglycemia are reported to occur predominantly in the occipital lobe, and the epileptic form is mainly epilepsia partialis continua. Of the two patterns of hyperglycemia (ketotic or nonketotic), nonketotic hyperglycemia is more commonly associated with seizures because ketosis has an anticonvulsive effect, so hyperglycemia-induced seizures are generally seen in nonketotic patients. Here, we report a 51-year-old Japanese male with intermittent homonymous hemianopsia who presented high hemoglobin A1c (19.1%). He had been drinking 3 L of the sugared soft beverage every day. After admission, he showed left-sided hemiconvulsion. Anti-seizure medications and insulin treatment were administered, and his seizure was aborted. The magnetic resonance imaging (MRI) showed a high-intensity lesion in the diffusion-weighted image and fluid-attenuated inversion recovery with gadolinium enhancement in the occipital lobe. In hyperglycemic convulsions, MRI sometimes shows leptomeningeal or parenchymal gadolinium enhancement. In addition, most hyperglycemic seizures are associated with nonketotic hyperglycemia and show occipital-dominant imaging abnormalities. We report this case by reviewing the differential diagnosis.
高血糖症有时最初会表现为神经学症状，包括癫痫发作、视幻觉、舞蹈手足徐动症、偏身投掷症、肌阵挛、震颤和意识障碍。据报道，高血糖诱发的癫痫发作主要发生在枕叶，癫痫形式主要为持续性部分性癫痫。在两种高血糖模式（酮症性或非酮症性）中，非酮症性高血糖与癫痫发作的关联更为常见，因为酮症具有抗惊厥作用，所以高血糖诱发的癫痫发作一般见于非酮症患者。在此，我们报告一名51岁的日本男性，他有间歇性同向性偏盲，糖化血红蛋白A1c水平较高（19.1%）。他每天饮用3升含糖软饮料。入院后，他出现左侧半身惊厥。给予了抗癫痫药物和胰岛素治疗，其惊厥得到控制。磁共振成像（MRI）显示在扩散加权图像上有高强度病变，枕叶在钆增强的液体衰减反转恢复序列上也有病变。在高血糖惊厥中，MRI有时显示软脑膜或实质钆增强。此外，大多数高血糖癫痫发作与非酮症性高血糖有关，并显示以枕叶为主的影像学异常。我们通过回顾鉴别诊断来报告该病例。
