title: Isolated aphasic status epilepticus as initial presentation of nonketotic hyperglycemia.
abstract: Diagnosis of aphasic status epilepticus is sometimes not easy because of its rarity and electroclinical dissociation. Although most cases are associated with organic brain lesions, nonketotic hyperglycemia (NKH)-related aphasic status epilepticus is rare, especially if it is isolated (without other clinical seizure activity). On the other hand, unlike other metabolic disorders, or hypoglycemia-related generalized seizures, focal motor seizure and epilepsia partialis continua can occur in 25% of NKH, with seizures being the initial manifestation in up to 50% of patients. However, the presentation of epileptic aphasia is rare in NKH patients. We report a rare case of NKH presenting initially as persistent and isolated aphasic status epilepticus. Brain magnetic resonance imaging did not reveal any focal lesion, but ictal electroencephalography (EEG) disclosed left frontotemporal continuous theta to delta waves, intermingled with epileptiform discharges. Correcting the hyperglycemia failed to improve the language disorder, and the seizure was controlled only by the addition of carbamazepine. Patients with NKH may initially present with isolated aphasic status epilepticus. Unlike stroke-related aphasia, accurate diagnosis is difficult if based solely on neurologic examination and brain neuroimaging. Use of EEG and blood sugar determination should be helpful in this special condition.
authors.affiliation: Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Ling-Chun
authors.initials: LC
authors.lastname: Huang
authors.forename: Diane
authors.initials: D
authors.lastname: Ruge
authors.forename: Chin-Ling
authors.initials: CL
authors.lastname: Tsai
authors.forename: Meng-Ni
authors.initials: MN
authors.lastname: Wu
authors.forename: Chung-Yao
authors.initials: CY
authors.lastname: Hsu
authors.forename: Chiou-Lian
authors.initials: CL
authors.lastname: Lai
authors.forename: Li-Min
authors.initials: LM
authors.lastname: Liou
mesh_terms: D000368:Aged; D001037:Aphasia / Q000175:diagnosis* / Q000209:etiology; D003937:Diagnosis, Differential; D004569:Electroencephalography / Q000379:methods; D006801:Humans; D020158:Hyperglycinemia, Nonketotic / Q000150:complications / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D012640:Seizures / Q000175:diagnosis* / Q000209:etiology; D013226:Status Epilepticus / Q000175:diagnosis* / Q000209:etiology
keywords: aphasic status epilepticus; carbamazepine; nonketotic hyperglycemia