Hyperglycemia with occipital seizures: images and visual evoked potentials.
OBJECTIVE
Hyperglycemia may rarely be seen with visual seizures. Observation of both visual evoked potentials (VEPs) and magnetic resonance imaging (MRI) in visual status epilepticus (SE) has not been reported. We describe acute and follow-up VEP and MRI findings of a patient with hyperglycemia-related visual SE of occipital origin.


METHODS
In a 59-year-old diabetic woman, complex visual hallucinations and illusions developed with < or =10 seizures per hour as an initial manifestation of nonketotic hyperglycemia.


RESULTS
Neurologic examination revealed ictal nystagmus to the right and continuous right hemianopsia. Ictal electroencephalography (EEG) and Tc-99m hexamethylpropylene amine oxime (HMPAO) single-photon emission computed tomography (SPECT) revealed an epileptogenic focus in the left occipital lobe. MRI with fluid-attenuated inversion recovery showed focal subcortical hypointensity and gyral hyperintensity. Follow-up MRI showed only minimal gyral hyperintensity at 6 months. The P100 amplitude of VEP was significantly higher at the right occipital area during SE, but slightly higher on the left after the patient had been seizure free for 6 months.


CONCLUSIONS
Occipital seizures and hemianopsia can be caused by hyperglycemia and may be accompanied by special MRI and VEP findings.
Wang
Chung-Pang
CP
Department of Emergency Medicine, Taichung Veterans General Hospital, #160 Sec. 3 Taichung-Kang Road, Taichung 407, Taiwan, R.O.C.
Hsieh
Peiyuan F
PF
Chen
Clayton Chi-Chang
CC
Lin
Wan-Yu
WY
Hu
Wei-Hsiung
WH
Yang
Dar-Yu
DY
Chang
Ming-Hong
MH
D004569:Electroencephalography / Q000706:statistics & numerical data; D004827:Epilepsy / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D005074:Evoked Potentials, Visual; D005260:Female; D007839:Functional Laterality; D006212:Hallucinations / Q000175:diagnosis / Q000503:physiopathology; D006423:Hemianopsia / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D007088:Illusions / Q000523:psychology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009778:Occipital Lobe / Q000098:blood supply / Q000000981:diagnostic imaging / Q000503:physiopathology*; D013226:Status Epilepticus / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon
D019690:Technetium Tc 99m Exametazime