SUBCORTICAL T2 HYPOINTENSITY IN SEIZURES WITH A NONKETOTIC HYPERGLYCEMIC HYPEROSMOLAR STATE

Abstract

Imaging features in seizures associated with a nonketotic hyperglycemia (NKH). A elderly female, known case of type 2 diabetes mellitus, presents with involuntary movements in left upper limb since 3 days. The MRI results revealed the presence of subcortical T2 hypo-intensity in the parieto-occipital white matter, along with cortical enhancement.  Areas of limited diffusion were visible using Diffusion Weighted Imaging (DWI). Encephalitis, cancer, and hemorrhagic infarct were among the radiologic differential diagnoses that were first evaluated, creating a difficult diagnostic situation.

BACKGROUND:NKH is a rather typical consequence of type 2 diabetes, particularly in people who are 50 or older. T2 hyper intensity has been reported to follow seizures on several occasions. Our patient, however, had localized T2 hypo intensity that exhibited strong clinic electrographic correlation.    

CASE STUDY:-48year-old women arrived to our health care center with complaints of involuntary movements 3 days back. She developed involuntary movements of left upper limb, which was insidious in onset, progressive, 6-7 episodes per day. It was not associated with loss of consciousness, vomiting, blurring of vision. She also complaints of right sided headache. Patient is a known of type 2 diabetes mellitus, not on any medications. Patient is also known case of hypertension.

INVESTIGATIONS:Tests for liver function, kidney function, and complete blood count were all normal. Patient did not have ketonuria.

Fasting blood sugar – 302 mg/dl

Postprandial blood sugar -505 mg/dl

HbA1C -14.8%

Serum Osmolality -294 mOsmol/l

EEG – Normal awake record