Magnetic resonance imaging features in seizures associated with nonketotic hyperglycemia

摘要

Sir,A 57-year-old female was admitted for episodic clonic jerks affecting her right face and arm, each episode lasting for approximately 2' of 10 days duration. There was no improvement of jerks with carbamazepine, instead there was increase in the frequency (every 5') and also developed right upper limb weakness. Past medical history was negative. Neurological examination revealed right hemiparesia. Admission serum glucose was 29.8 mmol/L with no ketone bodies in the urine; serum sodium was 133.8 mmol/L and potassium was 3.5 mmol/L; blood urea nitrogen was 6.0 mmol/L and calculated serum osmolality was 310.4 mmol/L. Admission computed tomography was normal. Electroencephalography (EEG) revealed inter-ictal epileptiform discharges around the left central sulcus [Figure la-c]. Brain magnetic resonance imaging (MRI) [Figure 2] done on day 2 of admission showed subcortical hypointensity signal changes in the left parietal region on T2-weighted (T2-W), fluid attenuated inversion recovery (FLAIR) and diffusion-weighted imaging (DWI). Apparent diffusion coefficient (ADC) map showed isointensity in the corresponding region. Overlying cortical showed hyperintensity on FLAIR, DWI sequences and hypointensity on ADC map. The ADC values in cortical and subcortical lesions were lower than contralateral normal regions, especially in cortical lesions. Tl-W sequences were normal. She was diagnosed as epileptia partialis continua (EPC) associated with nonketotic hyperglycemia (NKH). Carbamazepine was stopped and intravenous insulin therapy was started. She had good glycemic control and the jerking remitted completely within 72 h. Follow up MRI at 5 months showed complete resolution of cortical hyperintensity and subcortical hypointensity.