Published online Mar 6, 2021. doi: 10.12998/wjcc.v9.i7.1720
Peer-review started: November 14, 2020
First decision: November 24, 2020
Revised: December 6, 2020
Accepted: December 16, 2020
Article in press: December 16, 2020
Published online: March 6, 2021
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.
Core Tip: Nonketotic hyperglycemia is one of the most common endocrine emergencies. Patients with nonketotic hyperglycemia may present with various neurologic symptoms. We report a case of homonymous hemianopia with occipital seizures caused by hyperglycemia. Aggressive glycemic control and adequate hydration can reverse neurologic deficits. Subcortical T2 and fluid-attenuated inversion recovery hypointensity on resonance imaging were identified as characteristics.