Hyperglycemic hemianopia: A reversible complication of non-ketotic hyperglycemia

Abstract

Four patients each developed a reversible homonymous hemianopia caused by non-ketotic hyperglycemia. In two patients the homonymous hemianopia was the first manifestation of diabetes mellitus type 2. All four patients had abnormal MRI scans; in the three patients who had late follow-up scans the abnormalities resolved completely. In one patient the progressive visual field defect and unusual MRI findings initially caused concern for a tumor.

Characteristic MRI findings in hyperglycaemia-induced seizures: diagnostic value of contrast-enhanced fluid-attenuated inversion recovery imaging

“…8 Third, this may be due to intracellular dehydration of glial and supporting tissues. 6 Other clinical conditions that could induce T2 hypointensities on MRI include viral encephalitis, meningitis, leptomeningeal metastasis, haemorrhagic infarct, hypoxic insult, and moyamoya disease 23,24 ; however, a known uncontrolled hyperglycaemic state, additional MRI findings, and supportive EEG findings may help in reaching a diagnosis.…”

Clinical Reasoning: Acute-onset homonymous hemianopia with hyperglycemia

“…Symptoms are reversible with rapid correction of hyperglycemia. 2 Mechanisms of cerebral injury from hyperglycemia are unclear and may include intracellular dehydration from hyperosmolarity, reactive oxygen species generation, altered neurotransmitter function, local cerebrovascular ischemia, or altered intracellular enzyme mechanics. iron due to acidosis-induced reductions in transferrin affinity and subsequent reactive oxygen species generation.…”

Homonymous hemianopia in nonketotic hyperglycemia is an ictal phenomenon

“…1 The nature of this particular phenomenon is unclear, as partial seizures are common in NKH. We report evidence of ictal activity from EEG and functional imaging in 3 patients with NKH-associated HH, supporting the hypothesis that this condition is the result of recurrent partial seizures.…”