In 21 patients, epilepsia partialis continua (EPC) was an early symptom of nonketotic hyperglycemia and occurred during an initial phase of hyponatremia and mild hyperosmolality. EPC persisted for an average of 8 days, and its duration correlated predominantly with the degree of hyponatremia. Depression of consciousness and cessation of seizures occurred with increasing severity of hyperglycemia and hyperosmolality. In 9 patients, EPC was the first symptom leading to the diagnosis of diabetes mellitus. Four patients died of serious associated illness. The majority of the patients had evidence of a localized structural cerebral lesion. Metabolic disturbances including hyperglycemia, mild hyperosmolality, hyponatremia, and lack of ketoacidosis contribute to the development of EPC in areas of focal cerebral damage.

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A hypertensive patient with clinical and laboratory features of normal pressure hydrocephalus (NPH) but with evidence of bilateral multiple cerebral infarcts on computed tomography (CT) did not benefit from shunting. In six reported cases of hypertensive cerebrovascular disease with NPH, the result of shunting was not predictable and was generally disappointing. Laboratory criteria to predict which cases of NPH will benefit from shunting remain controversial. The chances of improvement after shunting are slight when there is CT evidence of bilateral multiple cerebral infarcts, even though other clinical and laboratory data might suggest NPH.