A 55-year-old man with diabetes mellitus type 2 presented with persistent right homonymous hemianopia of 72 hours evolution. At admission, the laboratory examination revealed blood glucose of 497 mg/dL and hyperosmolality without ketosis; the EEG did not show epileptic discharges. EEG done during the following days did not show any abnormalities. Brain MRI showed a subcortical lesion on the left occipital lobe (figure). The patient’s symptoms and MRI abnormalities resolved after glucose-lowering treatment.
On admission, brain MRI showed a left subcortical occipital lesion that was hypointense on fluid-attenuated inversion recovery, T2, susceptibility-weighted imaging, and apparent diffusion coefficient map (A–C and E) and hyperintense on diffusion-weighted imaging (D). A control brain MRI performed at 3 months was normal (F–H).
Nonketotic hyperglycemic hyperosmolar state is a condition associated with neurologic deficits that could mimic an acute ischemic stroke. The underlying mechanisms for MRI findings in this condition have not been fully elucidated, but it has been postulated that increased plasma osmolality with the subsequent development of hyperviscosity may lead to a hypoxic–ischemic insult resulting in the release of free radicals in the brain.1,2
Study funding
No targeted funding reported.
Disclosure
The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.
Appendix Authors
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Teaching slides links.lww.com/WNL/B190
- © 2020 American Academy of Neurology
Disputes & Debates: Rapid online correspondence
NOTE: All authors' disclosures must be entered and current in our database before comments can be posted. Enter and update disclosures at http://submit.neurology.org. Exception: replies to comments concerning an article you originally authored do not require updated disclosures.
- Stay timely. Submit only on articles published within the last 8 weeks.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- 200 words maximum.
- 5 references maximum. Reference 1 must be the article on which you are commenting.
- 5 authors maximum. Exception: replies can include all original authors of the article.
- Submitted comments are subject to editing and editor review prior to posting.