Recovery From Homonymous Hemianopia in Hyperglycemia-Induced Occipital Lobe Electroclinical Seizures Following Glycemic Control.

IF 2 4区 医学 Q3 CLINICAL NEUROLOGY
Journal of Neuro-Ophthalmology Pub Date : 2025-03-01 Epub Date: 2024-05-08 DOI:10.1097/WNO.0000000000002152
Charles E L Walker, Brendon W H Lee, Joanna E Offord, Hanka Laue-Gizzi, Shaun Watson, Ernest Somerville, Ashish Agar, Minas T Coroneo, Ian C Francis
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引用次数: 0

Abstract

Background: Visual changes due to hyperglycemia in diabetes are not uncommon. While blurred vision is a well-established sequela of chronic hyperglycemia, homonymous hemianopia with or without electroclinical seizures is much rarer and can be mistaken for migraine, temporal arteritis, or ischemia of the central nervous system.

Methods: This article analyzed case studies for 3 patients (67M, 68M, 52F) presenting with complex visual phenomena, from 3 to 42 days duration, including pathogenesis, clinical findings, management, and follow-up.

Results: Examinations demonstrated dense left homonymous hemianopias in 2 patients and a left inferior homonymous quadrantanopia in one, with no other abnormalities. Patients described vivid, nonstereotyped intermittent hallucinations in the affected fields. Blood glucose levels ranged from 13.5 to 35.0 mmol/L (243-630 mg/dL) without ketosis and HbA1c from 14.6% to 16.8%. Computed tomography of the brain showed no acute intracranial pathology. MRI of the brain either detected no abnormalities or demonstrated changes consistent with seizure activity. Electroencephalogram (EEG) demonstrated seizures over the right occipital region in each patient. EEG seizures coincided with patients' hallucinations, while they remained otherwise conscious. Oral hypoglycemic and antiepileptic medications were commenced with rapid and complete reversal of the seizures and visual field deficits, confirmed by repeat Automated 30-2 and MRI.

Conclusions: Hyperglycemia-induced occipital lobe seizures with visual hallucinations and interictal homonymous visual field defects represent a rare but clinically important diagnosis. This article highlights the importance of prompt recognition and treatment to facilitate recovery.

控制血糖后,高血糖诱发的枕叶电临床癫痫的同侧半身不遂的恢复。
背景:糖尿病患者因高血糖引起的视力改变并不少见。视力模糊是慢性高血糖的一种公认后遗症,但同侧偏盲伴有或不伴有临床电痉挛则更为罕见,可能被误诊为偏头痛、颞动脉炎或中枢神经系统缺血:本文分析了 3 名患者(67M、68M 和 52F)的病例研究,这些患者出现复杂的视觉现象,病程从 3 天到 42 天不等,包括发病机制、临床发现、处理和随访:检查结果显示,2 名患者出现密集的左同侧偏盲,1 名患者出现左下同侧象限视,无其他异常。患者描述受影响区域出现生动、非立体的间歇性幻觉。血糖水平在13.5至35.0毫摩尔/升(243至630毫克/分升)之间,无酮症,HbA1c在14.6%至16.8%之间。脑部计算机断层扫描显示没有急性颅内病变。脑部核磁共振成像要么未发现异常,要么显示出与癫痫活动一致的变化。脑电图(EEG)显示每位患者的右枕部都有癫痫发作。脑电图发作与患者的幻觉相吻合,而他们在其他方面仍保持清醒。患者开始口服降糖药和抗癫痫药后,癫痫发作和视野缺损迅速得到完全逆转,并通过重复自动30-2和核磁共振成像得到证实:结论:高血糖诱发的枕叶癫痫发作伴有视幻觉和发作间期同侧视野缺损是一种罕见但具有重要临床意义的诊断。本文强调了及时识别和治疗以促进患者康复的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Neuro-Ophthalmology
Journal of Neuro-Ophthalmology 医学-临床神经学
CiteScore
2.80
自引率
13.80%
发文量
593
审稿时长
6-12 weeks
期刊介绍: The Journal of Neuro-Ophthalmology (JNO) is the official journal of the North American Neuro-Ophthalmology Society (NANOS). It is a quarterly, peer-reviewed journal that publishes original and commissioned articles related to neuro-ophthalmology.
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