title: Occipital lobe seizures and subcortical T2 and T2* hypointensity associated with nonketotic hyperglycemia: a case report.
abstract: BACKGROUND
  Nonketotic hyperglycemia often causes seizures. Recently, seizures associated with nonketotic hyperglycemia have been found to be associated with subcortical T2 hypointensity on magnetic resonance imaging, especially in the occipital lobes. However, the mechanism remains unclear, although iron accumulation is suggested. We present a case of occipital lobe seizures associated with nonketotic hyperglycemia supporting the hypothesis that the mechanism of subcortical T2 hypointensity is iron accumulation using gradient-echo T2*-weighted magnetic resonance imaging.
  
  
  METHODS
  A 65-year-old Japanese man complained of intermittent pastel-colored flashing lights. On neurological examination, he also had lower right-side quadrant hemianopia. No other abnormal neurological findings were found. On laboratory analysis, his blood glucose level was 370 mg/dL, HbA1c was 11.4 %, and serum osmolarity was 326 mOsm/L. No ketones were detected in urine. A magnetic resonance imaging scan of his head showed subcortical T2 and T2* hypointensity in his left occipital lobe. Single-photon emission computed tomography with I123-N-isopropyl-iodoamphetamine revealed hyperperfusion in the left dominant occipital lobe. These magnetic resonance imaging abnormalities resolved during clinical recovery and treatment to control his blood sugar level. Therefore, a diagnosis of occipital lobe seizures associated with nonketotic hyperglycemia was made.
  
  
  CONCLUSIONS
  To the best of our knowledge, this is the first case of occipital lobe seizures associated with nonketotic hyperglycemia supporting the role of iron accumulation as a mechanism for subcortical T2 hypointensity using T2*-magnetic resonance imaging.
authors: Department of Neurology, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni-shi, Shizuoka, 410-2295, Japan.|Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
authors: Fuyuko
authors: F
authors: Sasaki
authors: Department of Neurology, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni-shi, Shizuoka, 410-2295, Japan. skawaji@juntendo.ac.jp.|Institute of Oriental Medicine, Tokyo Women's Medical University, 1-21-8 Tabata, Kita-ku, Tokyo, 114-0014, Japan. skawaji@juntendo.ac.jp.
authors: Sumihiro
authors: S
authors: Kawajiri
authors: Department of Neurology, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni-shi, Shizuoka, 410-2295, Japan.|Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
authors: Sho
authors: S
authors: Nakajima
authors: Department of Neurology, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni-shi, Shizuoka, 410-2295, Japan.
authors: Ai
authors: A
authors: Yamaguchi
authors: Department of Neurology, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni-shi, Shizuoka, 410-2295, Japan.
authors: Yuji
authors: Y
authors: Tomizawa
authors: Department of Neurology, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni-shi, Shizuoka, 410-2295, Japan.
authors: Kazuyuki
authors: K
authors: Noda
authors: Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
authors: Nobutaka
authors: N
authors: Hattori
authors: Department of Neurology, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni-shi, Shizuoka, 410-2295, Japan.
authors: Yasuyuki
authors: Y
authors: Okuma
mesh_terms: D000368:Aged; D006801:Humans; D006943:Hyperglycemia / Q000150:complications*; D007564:Japan; D008279:Magnetic Resonance Imaging; D008297:Male; D009778:Occipital Lobe / Q000000981:diagnostic imaging*; D012640:Seizures / Q000150:complications* / Q000000981:diagnostic imaging*
keywords: Case report; Iron accumulation; NKH; Seizure; Subcortical T2 hypointensity; Subcortical T2* hypointensity