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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2019; 29(04): 343-349
DOI: 10.4103/ijri.IJRI_344_19
Neuroimaging

Hyperglycemia-induced seizures - Understanding the clinico- radiological association

Shivaprakash B Hiremath
Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
Departments of Radiodiagnosis, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India
,
Amol A Gautam
Departments of Radiodiagnosis, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India
Department of Radiodiagnosis, Krishna Institute of Medical Sciences, Karad, Maharastra
,
Prince J George
Departments of Radiodiagnosis, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India
,
Agnes Thomas
Departments of Radiodiagnosis, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India
,
Reji Thomas
Departments of Neurology, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India
,
Geena Benjamin
Departments of Radiodiagnosis, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

Objectives: To highlight the typical magnetic resonance imaging (MRI) findings in hyperglycemia-induced seizures and compare the results with similar previous studies with a brief mention of pathophysiological mechanisms. Materials and Methods: This retrospective study included medical and imaging records of six consecutive patients with hyperglycemia-induced seizures. The data analysis included a clinical presentation and biochemical parameters at admission. The MRI sequences were evaluated for region involved, presence of subcortical T2 hypo-intensity, cortical hyper-intensity, and restricted diffusion. Similar previous studies from the National Library of Medicine (NLM) were analyzed and compared with our study. Results: Twenty-four patients were included from four studies in previous literature for comparison. In our study, on imaging, posterior cerebral region was predominantly involved, with parietal involvement in 83.3%, followed by occipital, frontal, and temporal involvement in 33.3% patients compared with occipital in 58.3%, parietal in 45.8%, and frontal and temporal in 16.6% of patients in previous literature. The subcortical T2 hypo-intensity was present in 83.3% of the patients, cortical hyper-intensity in all patients, and restricted diffusion in 66.6% of the patients in our study compared with subcortical T2 hypo-intensity in 95.8% of the patients, cortical hyper-intensity in 62.5%, and restricted diffusion in 58.3% of the patients in previous literature. Conclusion: Although many etiologies present with subcortical T2 hypointensity, cortical hyperintensity, restricted diffusion, and postcontrast enhancement on MRI, the clinical setting of seizures in a patient with uncontrolled hyperglycemia, hyperosmolar state, and absence of ketones should suggest hyperglycemia-induced seizures to avoid misdiagnosis, unnecessary invasive investigations, and initiate timely management. Advances in Knowledge: Our study highlights the presence of posterior predominant subcortical T2, fluid-attenuated inversion recovery (FLAIR), and susceptibility-weighted angiography (SWAN) hypointensity; cortical hyperintensity; and restricted diffusion in hyperglycemia-induced seizures. The presence of T2 and SWAN hypointensity could support the hypothesis of possible deposition of free radicals and iron in the subcortical white matter.

Keywords

Hyperglycemia - magnetic resonance imaging - seizures


Publication History

Received: 31 August 2019

Accepted: 23 December 2019

Article published online:
21 July 2021

© 2019. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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