Focal seizures as a manifestation of hyperglycemia without ketoacidosis

Abstract

Descriptions of hyperglycemia without ketoacidosis published since 1956 have been reviewed Twenty such cases were found. Seizures occurred in 2. A detailed description is given of 7 patients with nonketoacidotic hyperglycemia in whom seizures constituted the major presenting symptomatology. In 6 instances the seizures were focal. The seizures in our patients responded poorly to conventional treatment with anticonvulsants and were well controlled by rehydration and insulin. Ante- and postmortem studies in 6 of these patients revealed no evidence of gross structural brain disease. Two small areas of hemorrhagic cerebromalacia were found at autopsy in 1. It is suggested that hyperglycemia may elicit epileptic activity in a cortex with functional or small structural disturbances produced by some focal pathological process, such as vascular insufficiency. It is suggested that the epileptogenic action of hyperglycemia may be the result of accompanying hyperosmolarity or may be a direct toxic effect. Since the preparation of this manuscript another patient with seizures and nonketoacidotic hyperglycemia has been examined by us. The blood sugar on admission was 1,050 mg. %, blood urea N2 70 mg. percent, and CO2 19.8 mEq. per liter. The patient, a 70-year-old man, presented with right focal seizures which were well controlled with insulin and fluid therapy. The postictal right hemiparesis disappeared after 20 hours. The hyperglycemia recurred at the beginning of the 2nd hospital day, and both the seizures and the hemiparesis reappeared, continuing until the metabolic disturbance was again controlled.