Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2021; 9(7): 1720-1727
Published online Mar 6, 2021. doi: 10.12998/wjcc.v9.i7.1720
Hyperglycemic hemianopia: A case report
Xiao-Hui Xiang, Jia-Jia Fang, Mi Yang, Guo-Hua Zhao
Xiao-Hui Xiang, Jia-Jia Fang, Mi Yang, Guo-Hua Zhao, Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China
Author contributions: Xiang XH drafted the manuscript for intellectual content; Yang M collected the clinical data; Fang JJ and Zhao GH revised the manuscript for intellectual content; all authors read and approved the final manuscript.
Supported by The fund of Department of Education Zhejiang Province Scientific Research Project, No. Y201839721; Zhejiang Province Medical Science and Technology Project, No. 2017174708, No. 2020RC061, and No. 2018273034; the Zhejiang Provincial Natural Scientific Foundation of China, No. LGF20H090011 and No. LY18H090002; Zhejiang public welfare Technology Application Research Project, No. LGF20H090011; and the Medical and Health Science and Technology Program of Zhejiang Province, No. 2018273034.
Informed consent statement: Written informed consent was obtained from each participant for publication of this case report.
Conflict-of-interest statement: The authors declare that they have no competing interests.
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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:
Corresponding author: Guo-Hua Zhao, MD, Doctor, Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, No. N1 Shangcheng Avenue, Yiwu 322000, Zhejiang Province, China.
Received: November 14, 2020
Peer-review started: November 14, 2020
First decision: November 24, 2020
Revised: December 6, 2020
Accepted: December 16, 2020
Article in press: December 16, 2020
Published online: March 6, 2021

Nonketotic hyperglycemia (NKH) is characterized by hyperglycemia with little or no ketoacidosis. Diverse neurological symptoms have been described in NKH patients, including choreoathetosis, hemiballismus, seizures, and coma in severe cases. Homonymous hemianopia, with or without occipital seizures, caused by hyperglycemia is less readily recognized.


We describe a 54-year-old man with NKH, who reported seeing round, colored flickering lights with right homonymous hemianopia. Cranial magnetic resonance imaging demonstrated abnormalities in the left occipital lobe, with decreased T2 signal of the white matter, restricted diffusion, and corresponding low signal intensity in the apparent diffusion coefficient map. He responded to rehydration and a low-dose insulin regimen, with improvements of his visual field defect.


Patients with NKH may present focal neurologic signs. Hyperglycemia should be taken into consideration when making an etiologic diagnosis of homonymous hemianopia.

Keywords: Nonketotic hyperglycemia, Homonymous hemianopia, Occipital seizures, Imaging manifestations, Case report

Core Tip: Nonketotic hyperglycemia is one of the most common endocrine emergencies. Patients with nonketotic hyperglycemia may present with various neurologic symptoms. We report a case of homonymous hemianopia with occipital seizures caused by hyperglycemia. Aggressive glycemic control and adequate hydration can reverse neurologic deficits. Subcortical T2 and fluid-attenuated inversion recovery hypointensity on resonance imaging were identified as characteristics.