Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2024; 12(5): 1004-1009
Published online Feb 16, 2024. doi: 10.12998/wjcc.v12.i5.1004
Neuroimaging features in a patient with non-ketotic hyperglycaemic seizures: A case report
Jing Wu, Huijie Feng, Yaxiong Zhao, Junfeng Li, Ting Li, Kefeng Li
Jing Wu, Huijie Feng, Yaxiong Zhao, Junfeng Li, Ting Li, Department of Radiology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi 046000, Shanxi Province, China
Jing Wu, Huijie Feng, Yaxiong Zhao, Junfeng Li, Ting Li, Changzhi Key Lab of Functional Imaging for Brain Diseases, Heping Hospital Affiliated to Changzhi Medical College, Changzhi 046000, Shanxi Province, China
Kefeng Li, Faculty of Applied Sciences, Macao Polytechnic University, Macau 999078, China
Co-corresponding authors: Kefeng Li and Ting Li.
Author contributions: Wu J, Feng H, Zhao Y, and Li K conceived the article and wrote the manuscript draft; Wu J, Li J, and Li T were involved in the clinical care of the patient. Both Li T and Li K have played important and indispensable roles in the experimental design, data interpretation and manuscript preparation as the co-corresponding authors. Li T conceptualized, designed, and supervised the whole process of the project. Li K was instrumental and responsible for data re-analysis and re-interpretation, figure plotting, comprehensive literature search, preparation and submission of the current version of the manuscript. This collaboration between Li K and Li T is crucial for the publication of this manuscript and other manuscripts still in preparation. All authors critically reviewed the manuscript for intellectual content and edited the article.
Supported by Four "Batches" Innovation Project of Invigorating Medical Through Science and Technology of Shanxi Province, No. 2023XM016.
Informed consent statement: Informed consent for publication was obtained from the patient’s guardian.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kefeng Li, PhD, Associate Professor, Faculty of Applied Sciences, Macao Polytechnic University, R. de Luís Gonzaga Gomes, Macau 999078, China. kefengl@mpu.edu.mo
Received: October 27, 2023
Peer-review started: October 27, 2023
First decision: November 28, 2023
Revised: December 27, 2023
Accepted: January 17, 2024
Article in press: January 17, 2024
Published online: February 16, 2024
Processing time: 95 Days and 17.5 Hours
Abstract
BACKGROUND

Non-ketotic hyperglycaemic (NKH) seizures are a rare neurological complication of diabetes caused by hyperglycaemia in non-ketotic and non-hyperosmotic states. The clinical characteristics of NKH seizures are atypical and lack unified diagnostic criteria, leading to potential misdiagnoses in the early stages of the disease.

CASE SUMMARY

This report presents a rare case of NKH seizures in a 52-year-old male patient with a history of type 2 diabetes mellitus. We performed comprehensive magnetic resonance imaging (MRI) studies at admission, 12 d post-admission, and 20 d post-discharge. The imaging techniques included contrast-enhanced head MRI, T2-weighted imaging (T2WI), fluid-attenuated inversion recovery (FLAIR), diffusion-weighted imaging, susceptibility-weighted imaging, magnetic resonance spectroscopy (MRS), and magnetic resonance venography. At the time of admission, T2WI and FLAIR of the cranial MRI showed that the left parieto-occipital cortex had gyrus-like swelling and high signal, and subcortical stripes had low signal. MRS showed a reduced N-acetylaspartate peak and increased creatine and choline peaks in the affected areas. A follow-up MRI 20 d later showed that the swelling and high signal of the left parieto-occipital cortex had disappeared, and the low signal of the subcortex had disappeared.

CONCLUSION

This case study provides valuable insights into the potential pathogenesis, diagnosis, and treatment of NKH seizures. The comprehensive MRI findings highlight the potential utility of various MRI sequences in diagnosing and characterizing NKH seizures.

Keywords: Non-ketotic hyperglycaemia seizures; Magnetic resonance imaging; Magnetic resonance spectroscopy; Diabetes; Case report

Core Tip: This study presents a rare case of non-ketotic hyperglycaemic (NKH) seizures in a patient with type 2 diabetes. These seizures are a complication of diabetes, though they lack specific diagnostic criteria and are often misdiagnosed. In particular, the magnetic resonance imaging (MRI) findings of these manifestation have rarely been described in the literature, and previous reports are inconsistent. In this report, we describe the comprehensive findings in several MRI sequences, including T2-weighted images, fluid-attenuated inversion recovery, diffusion-weighted imaging, susceptibility-weighted imaging, and magnetic resonance spectroscopy and venography. We believe that our study makes a significant contribution to the literature because these findings can help elucidate the pathogenesis, diagnosis, and treatment of this rare condition. Further, we believe that this paper will be of interest to the readership of your journal because this case report expands the clinical knowledge on NKH seizures, a rare but severe complication of diabetes.