Postictal Focal Cortical High Signal Intensity Changes on MRI in Nonketotic Hyperglycemic Seizures

Abstract

Case report: A 48-year old male with diabetes mellitus was taking oral hypoglycemic agents for the previous three years, but had stopped medication for the last three months. On the day before admission, MRI of the head revealed no significant abnormalities. Blood glucose was elevated (23.7 mmol/L), hemoglobin A1c concentration was 12.6%, and serum osmolarity was 285.3 mOsm/L on the day 1 admission. The first several days after admission, the patient with recurrent NKH seizures and loss of consciousness were obtained. On hospital day 5, T2-weighted MRI demonstrated gray matter hyperintensity in the left temporal cortex. When hyperglycemia and seizures was controlled by insulin, he was discharged and prescribed insulin subcutaneous. On follow-up two months later, the hyperintensity had subsided in the left temporal cortex.

Conclusions: Our observations demonstrated that the postictal focal hyperintensity cortex signal should be attributed to the
cell edema with laminar necrosis provoked by NKH focal seizures, but are reversible when hyperglycemia and seizures are well
controlled by insulin. This information may be important in patient with diabetes enduring treatment.