title: Hyperglycemia with occipital seizures: images and visual evoked potentials.
abstract: 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.
authors: Department of Emergency Medicine, Taichung Veterans General Hospital, #160 Sec. 3 Taichung-Kang Road, Taichung 407, Taiwan, R.O.C.
authors: Chung-Pang
authors: CP
authors: Wang
authors: Peiyuan F
authors: PF
authors: Hsieh
authors: Clayton Chi-Chang
authors: CC
authors: Chen
authors: Wan-Yu
authors: WY
authors: Lin
authors: Wei-Hsiung
authors: WH
authors: Hu
authors: Dar-Yu
authors: DY
authors: Yang
authors: Ming-Hong
authors: MH
authors: Chang
mesh_terms: 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
chemical_list: D019690:Technetium Tc 99m Exametazime