1
|
Aljaberi K, Salih N, Palat AN, Palat Chirkkara SK. Non-ketotic Hyperglycemia Presenting as Focal Status Epilepticus and Subsequent Todd's Paralysis. Cureus 2024; 16:e63460. [PMID: 39077240 PMCID: PMC11285252 DOI: 10.7759/cureus.63460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2024] [Indexed: 07/31/2024] Open
Abstract
Uncontrolled diabetes can result in many neurological and non-neurological complications. It's common for hypoglycemia to present as a seizure; however, in cases of hyperglycemia, especially in the absence of ketones, seizures are uncommon. Here, we present a case of a 75-year-old female with no prior history of epilepsy disorder presenting as focal status epilepticus complicated by Todd's paralysis. We are describing the case with a review of the current literature.
Collapse
Affiliation(s)
| | - Nihal Salih
- Neurology, Sheikh Shakhbout Medical City, Abu Dhabi, ARE
| | | | | |
Collapse
|
2
|
Wu J, Feng H, Zhao Y, Li J, Li T, Li K. Neuroimaging features in a patient with non-ketotic hyperglycaemic seizures: A case report. World J Clin Cases 2024; 12:1004-1009. [PMID: 38414607 PMCID: PMC10895633 DOI: 10.12998/wjcc.v12.i5.1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/27/2023] [Accepted: 01/17/2024] [Indexed: 01/31/2024] Open
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.
Collapse
Affiliation(s)
- Jing Wu
- Department of Radiology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi 046000, Shanxi Province, China
- Changzhi Key Lab of Functional Imaging for Brain Diseases, Heping Hospital Affiliated to Changzhi Medical College, Changzhi 046000, Shanxi Province, China
| | - Huijie Feng
- Department of Radiology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi 046000, Shanxi Province, China
- Changzhi Key Lab of Functional Imaging for Brain Diseases, Heping Hospital Affiliated to Changzhi Medical College, Changzhi 046000, Shanxi Province, China
| | - Yaxiong Zhao
- Department of Radiology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi 046000, Shanxi Province, China
- Changzhi Key Lab of Functional Imaging for Brain Diseases, Heping Hospital Affiliated to Changzhi Medical College, Changzhi 046000, Shanxi Province, China
| | - Junfeng Li
- Department of Radiology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi 046000, Shanxi Province, China
- Changzhi Key Lab of Functional Imaging for Brain Diseases, Heping Hospital Affiliated to Changzhi Medical College, Changzhi 046000, Shanxi Province, China
| | - Ting Li
- Department of Radiology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi 046000, Shanxi Province, China
- 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
| |
Collapse
|
3
|
Manorenj S, Venniveli D, Reddy ME, Billa S. Ictal Nystagmus in a Patient with Nonketotic Hyperglycemia: A Rare Clinical Phenomenon of Occipital Epilepsy. Ann Indian Acad Neurol 2024; 27:77-79. [PMID: 38495234 PMCID: PMC10941902 DOI: 10.4103/aian.aian_800_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/05/2023] [Accepted: 12/10/2023] [Indexed: 03/19/2024] Open
Affiliation(s)
- Sandhya Manorenj
- Department of Neurology, Princess Esra Hospital, Deccan College of Medical Sciences, Hyderabad, Telangana, India
| | - Deepika Venniveli
- Department of Neurology, Princess Esra Hospital, Deccan College of Medical Sciences, Hyderabad, Telangana, India
| | - Mounika E. Reddy
- Department of Neurology, Princess Esra Hospital, Deccan College of Medical Sciences, Hyderabad, Telangana, India
| | - Srujana Billa
- Department of Neurology, Princess Esra Hospital, Deccan College of Medical Sciences, Hyderabad, Telangana, India
| |
Collapse
|
4
|
Bharathi SS, Zhang BB, Paul E, Zhang Y, Schmidt AV, Fowler B, Wu Y, Tiemeyer M, Inamori KI, Inokuchi JI, Goetzman ES. GM3 synthase deficiency increases brain glucose metabolism in mice. Mol Genet Metab 2022; 137:342-348. [PMID: 36335793 PMCID: PMC11061803 DOI: 10.1016/j.ymgme.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
GM3 synthase (GM3S) deficiency is a rare neurodevelopmental disorder caused by an inability to synthesize gangliosides, for which there is currently no treatment. Gangliosides are brain-enriched, plasma membrane glycosphingolipids with poorly understood biological functions related to cell adhesion, growth, and receptor-mediated signal transduction. Here, we investigated the effects of GM3S deficiency on metabolism and mitochondrial function in a mouse model. By indirect calorimetry, GM3S knockout mice exhibited increased whole-body respiration and an increased reliance upon carbohydrate as an energy source. 18F-FDG PET confirmed higher brain glucose uptake in knockout mice, and GM3S deficient N41 neuronal cells showed higher glucose utilization in vitro. Brain mitochondria from knockout mice respired at a higher rate on Complex I substrates including pyruvate. This appeared to be due to higher expression of pyruvate dehydrogenase (PDH) and lower phosphorylation of PDH, which would favor pyruvate entry into the mitochondrial TCA cycle. Finally, it was observed that blocking glucose metabolism with the glycolysis inhibitor 2-deoxyglucose reduced seizure intensity in GM3S knockout mice following administration of kainate. In conclusion, GM3S deficiency may be associated with a hypermetabolic phenotype that could promote seizure activity.
Collapse
Affiliation(s)
- Sivakama S Bharathi
- Division of Genetic and Genomic Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Bob B Zhang
- Division of Genetic and Genomic Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Eli Paul
- Division of Genetic and Genomic Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Yuxun Zhang
- Division of Genetic and Genomic Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Alexandra V Schmidt
- Division of Genetic and Genomic Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Benjamin Fowler
- Division of Genetic and Genomic Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Yijen Wu
- Department of Developmental Biology, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States of America
| | - Michael Tiemeyer
- Complex Carbohydrate Research Center, University of Georgia, Athens, GA, United States of America
| | - Kei-Ichiro Inamori
- Division of Glycopathology, Institute of Molecular Biomembrane and Glycobiology, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi 981-8558, Japan
| | - Jin-Ichi Inokuchi
- Division of Glycopathology, Institute of Molecular Biomembrane and Glycobiology, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi 981-8558, Japan
| | - Eric S Goetzman
- Division of Genetic and Genomic Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America..
| |
Collapse
|