[Partial visual seizures induced by non-ketosic hyperglycemia: magnetic resonance imaging and visual evoked potential descriptions. A study of two cases reports with radiologic and electrophysiologic abnormalities].
BACKGROUND
Non-ketosic hyperglycemia (NKH) may increase the likelihood of focal epileptic seizures, including commonly motor expression; rarely, they can have a visual expression.


METHODS
The authors describe the observation of two men, who were hospitalized for visual manifestations; with episodes of homonymous hemianopia and hallucinations, revealing occipital seizure, secondary to NKH. Clinical data and characteristics of the investigations, including radiological imaging (MRI) and electrophysiological results of visual evoked potentials (VEP) are specified.


RESULTS
MRI showed transitory low signal on T2 and FLAIR in occipital areas. Spectro-MR identified a moderate diminution of the NAA and lipids spikes, compatible with laminar necrosis. VEP revealed a transient decrease of the P100 amplitude.


CONCLUSIONS
These two observations underline the existence of acute symptomatic seizures with a visual starting point which is often indicative of diabetes. Through these observations with a review of 28 patients from the literature, MR imaging characteristics and possible anomalies collected on VEP are discussed. Such seizures are resistant to anticonvulsant treatment and respond best to insulin and rehydration.


CONCLUSIONS
The visual manifestations indicative of seizures with an occipital starting point in the context of NKH are possible enabling rapid initiation of effective symptomatic treatment with insulin.
Service de neurologie, HIA Desgenettes, 108, boulevard Pinel, 69275 Lyon cedex 03, France.
A
A
Donat
L
L
Guilloton
C
C
Bonnet
G
G
Depreux
J-L
JL
Lamboley
A
A
Drouet
D000927:Anticonvulsants / Q000627:therapeutic use; D001786:Blood Glucose / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D038524:Diffusion Magnetic Resonance Imaging; D004359:Drug Therapy, Combination; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D005074:Evoked Potentials, Visual; D006442:Glycated Hemoglobin / Q000032:analysis; D006212:Hallucinations / Q000209:etiology*; D006423:Hemianopsia / Q000209:etiology*; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging / Q000379:methods; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D009778:Occipital Lobe / Q000473:pathology / Q000503:physiopathology*; D012640:Seizures / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D014794:Visual Fields
D000927:Anticonvulsants; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin