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Hyperglycemic Seizures

Hyperglycemia-induced Involuntary Movements: 2 Case Reports And A Review Of The Literature

Hyperglycemia-induced Involuntary Movements: 2 Case Reports And A Review Of The Literature

1From the SUNY Downstate Medical Center, James J. Peters VAMC, Bronx, New York, and Mount Sinai School of Medicine, New York City, New York 2Department of Neurology, James J. Peters VAMC, Bronx, New York, and Mount Sinai School of Medicine, New York City, New York 3VHA NY Harbor Healthcare System - Brooklyn Campus, Brooklyn, New York. Objective: Autonomic and peripheral neurologic manifestations of hyperglycemia are commonly seen in clinical practice; acute hyperglycemia-induced involuntary movements (HIIM) are rarer and less well known. In this article we describe 2 patients with HIIM and review the scientific literature to better characterize the clinical and pathophysiologic features of these disorders. Methods: A literature search was performed using the PubMed database. Whenever possible, the most recent publication on a topic was utilized, with a 20-year cutoff time since publication. Articles were selected based on the quality of presented data or citations utilized. Results: HIIM can present in a variety of ways including seizures, hemichorea-hemiballismus (HCHB) and, very rarely, tremor. While HIIM are more commonly seen in patients with long-standing, uncontrolled diabetes, they can also be the initial presentation of diabetes. The precise pathophysiology of HIIM remains unknown; however, at least for HCHB, it is hypothesized that hyperglycemia increases the metabolism of the inhibitory neurotransmitter gamma aminobutyric acid (GABA), thereby lowering the seizure threshold. It may also cause regional cerebral vascular insufficiency. Treatment of HIIM differs from that for seizures and other movement disorders in that it relies primarily on glucose control. Conclusion: It is important to recognize hyperglycemia as a cause of involuntary movements so as to provi Continue reading >>

Seizure Assessment In The Emergency Department

Seizure Assessment In The Emergency Department

A seizure is an episode of neurologic dysfunction caused by abnormal neuronal activity that results in a sudden change in behavior, sensory perception, or motor activity. The clinical spectrum of seizures includes simple and complex focal or partial seizures and generalized seizures. The term “epilepsy” refers to recurrent, unprovoked seizures from known or unknown causes. The term “ictus” describes the period in which the seizure occurs, and the term “postictal” refers to the period after the seizure has ended but before the patient has returned to his or her baseline mental status. A focal or partial seizure consists of abnormal neuronal firing that is limited to 1 hemisphere or area of the brain and that manifests itself as seizure activity on 1 side of the body or one extremity. These seizures are classified as simple partial if there is no change in mental status or complex partial if there is some degree of impaired consciousness. A generalized seizure consists of abnormal electrical activity involving both cerebral hemispheres that causes an alteration in mental status. Traditionally, the patient with 30 minutes of continuous seizure activity or a series of seizures without a return to full consciousness is defined as being in status epilepticus (SE). Newer definitions suggest that SE is defined by duration of 5 continuous minutes of generalized seizure activity or 2 or more separate seizure episodes without return to baseline. [1] This article focuses on the emergency department (ED) evaluation, management, and disposition of adult patients presenting for evaluation of seizure. Febrile seizures in children are a distinct entity and are discussed in a separate article. Continue reading >>

Complex Partial Seizure As A Manifestation Of Non-ketotic Hyperglycemia: The Needle Recovered From Haystack?

Complex Partial Seizure As A Manifestation Of Non-ketotic Hyperglycemia: The Needle Recovered From Haystack?

Go to: Case Report A 75-year-old gentleman presented to the accident and emergency department (A&E) following an episode of fall at home and was found by his wife on a bathroom floor. Initial neurological examination revealed global aphasia with right-sided hemiparesis. He was noted to be incontinent of urine. His medical history included atrial fibrillation, hypertension, benign prostatic hypertrophy and chronic obstructive pulmonary disease. His medications included warfarin, tamsulosin, seretide, felodipine and candesartan. He has no physical disability, independent prior to hospital admission. On presentation, he was hemodynamically stable with a GCS of 11/15 (E4/V1/M6). Initial blood parameters including inflammatory markers were within normal limits. Each episode of seizures lasted less than a minute. They were all self-terminating. He was commenced on phenytoin infusion. CT brain revealed an old lacunar infarct in the left basal ganglia. He was transferred to the stroke ward for further observation and treatment. It was noted he had been developing further seizure clusters despite IV phenytoin. Each seizure episode lasted between 3 and 5 min. Nursing documentation revealed at least 20 stereotypical movements within the first 24 h. On the second day of his admission, his CRP had risen and he was commenced treatment for aspiration pneumonia. MRI brain was unremarkable with no evidence of temporal or meningeal enhancement (Fig. 1). Lumbar puncture was delayed in view of his abnormal INR. His random blood sugar measurement was recorded at 30 mmol/L with HbA1c measurement of 14.8%. He was commenced on IV insulin with subsequent reduction of seizure frequency. He was seizure free within 24 h and discharged uneventfully with oral metformin. He was reportedly still seizu Continue reading >>

Sweet Seizures – Epilepsia Partialis Continua

Sweet Seizures – Epilepsia Partialis Continua

Ragesh Panikkath MDa, Joaquin Abeal Lado MDb Correspondence to Ragesh Panikkath MD Email: [email protected] SWRCCC : 2013;1.(3):29-31 doi: 10.12746/swrccc2013.0103.032 ................................................................................................................................................................................................................................................................................................................................... Abstract Epilepsia partialis continua (EPC) refers to focal and recurrent seizures that happen every few seconds to minutes for extended periods of time. The most common causes of these seizures are stroke, Rasmussen’s encephalitis (in children), and viral encephalitis. Metabolic disorders, like hyperglycemic hyperosmolar state (HHS),infrequently cause EPC. Correction of the HHS stops the EPC and eliminates the need for antiepileptic drugs. Synaptic transmission in the central nervous system requires normal glucose concentrations. Hyperglycemia can lower the seizure threshold, and this possibly explains the development of seizures in patients with HHS. Keywords: Hyperglycemic hyperosmolar state, epilepsia partialis continua, focal seizures, diabetes ................................................................................................................................................................................................................................................................................................................................... Introduction Epilepsia partialis continua (EPC) refers to focal and recurrent seizures that happen every few seconds to minutes for extended periods of time.1 Cerebrovascular stroke, Rasmussen’s encephalitis, a Continue reading >>

Hyperglycemia

Hyperglycemia

Not to be confused with the opposite disorder, hypoglycemia. Hyperglycemia, or high blood sugar (also spelled hyperglycaemia or hyperglycæmia) is a condition in which an excessive amount of glucose circulates in the blood plasma. This is generally a blood sugar level higher than 11.1 mmol/l (200 mg/dl), but symptoms may not start to become noticeable until even higher values such as 15–20 mmol/l (~250–300 mg/dl). A subject with a consistent range between ~5.6 and ~7 mmol/l (100–126 mg/dl) (American Diabetes Association guidelines) is considered slightly hyperglycemic, while above 7 mmol/l (126 mg/dl) is generally held to have diabetes. For diabetics, glucose levels that are considered to be too hyperglycemic can vary from person to person, mainly due to the person's renal threshold of glucose and overall glucose tolerance. On average however, chronic levels above 10–12 mmol/L (180–216 mg/dL) can produce noticeable organ damage over time. Signs and symptoms[edit] The degree of hyperglycemia can change over time depending on the metabolic cause, for example, impaired glucose tolerance or fasting glucose, and it can depend on treatment.[1] Temporary hyperglycemia is often benign and asymptomatic. Blood glucose levels can rise well above normal and cause pathological and functional changes for significant periods without producing any permanent effects or symptoms. [1] During this asymptomatic period, an abnormality in carbohydrate metabolism can occur which can be tested by measuring plasma glucose. [1] However, chronic hyperglycemia at above normal levels can produce a very wide variety of serious complications over a period of years, including kidney damage, neurological damage, cardiovascular damage, damage to the retina or damage to feet and legs. Diabetic n Continue reading >>

Diabetic Seizures In Dogs

Diabetic Seizures In Dogs

Seeing your dog have a seizure can be pretty scary, especially the first time this happens. If the seizure is caused by diabetes complications, the good news is that future seizures can be prevented by controlling the dog's diabetes. Why Seizures Happen Any seizure—in a dog or a human—is caused by a kind of electrical storm in the brain. If a dog has diabetes, her body doesn't produce the right amount of insulin for control of blood sugar levels. Insulin is produced by the pancreas, and diabetes can be caused by too much or too little. Very low blood sugar levels can interrupt the normal functioning of the brain, leading to a diabetic seizure. Hypoglycemia and Hyperglycemia Problems relating to diabetes in dogs usually stem from a state of either hypoglycemia or hyperglycemia. A hypoglycemic dog has very low blood sugar and may experience a seizure as a result. In diabetic dogs, hypoglycemia commonly occurs when an insulin dose is given without sufficient food for the dog's body to utilize the insulin properly. The opposite diabetic state, hyperglycemia, occurs when the dog's blood sugar levels are extremely high. Although hyperglycemia does not typically cause seizures, this is a serious state in which the dog may become depressed, weak and anorexic. Hyperglycemia can cause a dog to become comatose. Seizure Prevention If your dog is diabetic, seizure prevention primarily involves preventing a state of hypoglycemia. Use insulin that is formulated specifically for dogs—Novolin, Vetsulin and Caninsulin are some of the most commonly used forms of canine insulin. Monitor your dog's blood glucose regularly to make sure the insulin dosage is correct and having the desired effect. Monitor your dog's feeding and exercise patterns, if possible with a regular daily schedule Continue reading >>

Hyperglycemia

Hyperglycemia

Hyperglycemia means high blood sugar. It is the primary symptom of diabetes. Unlike its opposite, hypoglycemia, hyperglycemia is not immediately life-threatening. This doesn't mean it's not dangerous, though. For "how high is high", see blood glucose levels, and also the long-term symptoms discussion at the end of this page. Increasing physical activity can mean lowering blood sugar levels for some pets and people with this disease. It can also raise them; much depends on individual reaction and knowing how you or your pet responds. For most with diabetes, excitement or stress can cause temporary hyperglycemia. There are others who can find themselves going toward hypoglycemia because of it. Some unexpected causes of hyperglycemia are discussed in detail under regulation difficulties. Because of the hyperglycemia Cushing's disease creates, it's possible (but not frequent) to find ketones in the urine. [1] An untreated diabetic suffers primarily from lack of insulin to let nourishment into the cells, and therefore is starving to death. But hyperglycemia can kill faster than starvation; it's not unusual for one of the effects below, or diabetic ketoacidosis (DKA) brought on by the combination, to be the actual fatal blow. Hyperglycemia and glycosuria are the symptoms, or signs, that the untreated or inadequately treated diabetic is unable to metabolize carbohydrates properly. This is caused by a lack of insulin, endogenous or exogenous, in the body to assist in this process. Depending on the severity and length of time spent in hyperglycemia, diabetics will suffer various levels of severity of symptoms, ranging from short term to long term. Almost all complications of diabetes are caused directly or indirectly by hyperglycemia [2]. Excess sugar in the blood is: Removed by Continue reading >>

Partial Seizures And Aphasia As Initial Manifestations Of Non-ketotic Hyperglycemia

Partial Seizures And Aphasia As Initial Manifestations Of Non-ketotic Hyperglycemia

COMPLEX CASE REPORT MARCUS SABRY AZAR BATISTA* DÉLRIO FAÇANHA SILVA**, HENRIQUE BALLALAI FERRAZ***, LUIZ AUGUSTO FRANCO DE ANDRADE**** ABSTRACT - We describe a case of non-ketotic hyperglycemia (NKH), heralded by complex partial seizures and aphasia of epileptic origin, besides versive and partial motor seizures. This clinical picture was accompanied by left fronto-temporal spikes in the EEG. The seizures were controlled by carbamazepine only after the control of the diabetes. A month later, carbamazepine was discontinued. The patient remained without seizures, with normal language, using only glybenclamide. Complex partial seizures, opposed to simple partial seizures, are rarely described in association to NKH. Epileptic activity localized over language regions can manifest as aphasia. KEY WORDS: aphasia, seizures, diabetes mellitus. Crises parciais complexas e afasia como manifestações iniciais de hiperglicemia não cetótica: relato de caso RESUMO - Descrevemos um caso de hiperglicemia não-cetótica (HNC) cujas manifestações iniciais foram crises parciais complexas e afasia de origem epiléptica, além de crises versivas e parcias motoras. Este quadro clínico foi acompanhado por atividade epileptiforme na região fronto-temporal esquerda ao eletrencefalograma. As crises epilépticas foram controladas com carbamazepina (CBZ) apenas após o controle do diabetes mellitus. Após um mês, a CBZ foi suspensa, permanecendo a paciente com linguagem normal, sem novas crises epilépticas, em uso apenas de glibenclamida. Crises parciais complexas, ao contrário de crises parciais simples, são raramente descritas como manifestação de HNC. Atividade epileptiforme nas regiões relacionadas a linguagem podem manifestar-se como afasia. PALAVRAS-CHAVE: epilepsia, crises ep Continue reading >>

Case Report Occipital Seizures Induced By Hyperglycemia: A Case Report And Review Of Literature

Case Report Occipital Seizures Induced By Hyperglycemia: A Case Report And Review Of Literature

Abstract An 83-year-old right-handed male presented with a 2-day history of episodic jerking and “spasms” in the left arm, each lasting approximately 1 min, followed by weakness. He also described episodes of flashing colorful lights (green and blue) in his left visual field, not always accompanied by arm jerking, associated with intermittent confusion. His past medical history was significant for type-2 diabetes mellitus. Neurological exam showed an intermittent visual deficit in both eyes, in the inferior fields, mild left upper extremity weakness with brisk reflexes. Several brief episodes of focal motor (clonic) seizure activity involving the left upper limb were observed. Blood glucose was 639 mg/dL, with serum osmolarity of 316 mosmol/L. Ketoacidosis was absent. Two electrographic seizures from the left occipital region maximum at O1 associated with visual symptoms were recorded. CT head performed on the day of admission was normal. MRI was not done because of a pacemaker. Patient was treated with hydration and insulin and all the neurological symptoms including the seizures disappeared after 24 h. We report a patient with clinical and electrographic seizures from the occipital region associated with hyperglycemia. This is a unique complication of hyperglycemia and anecdotal reports of patients with this clinical presentation have been published over the years. Sporadic EEG descriptions have been reported before. Continue reading >>

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Pardon Our Interruption...

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Diabetic Hyperglycemia Aggravates Seizures And Status Epilepticus-induced Hippocampal Damage

Diabetic Hyperglycemia Aggravates Seizures And Status Epilepticus-induced Hippocampal Damage

Abstract Epileptic seizures in diabetic hyperglycemia (DH) are not uncommon. This study aimed to determine the acute behavioral, pathological, and electrophysiological effects of status epilepticus (SE) on diabetic animals. Adult male Sprague-Dawley rats were first divided into groups with and without streptozotocin (STZ)-induced diabetes, and then into treatment groups given a normal saline (NS) (STZ-only and NS-only) or a lithium-pilocarpine injection to induce status epilepticus (STZ + SE and NS + SE). Seizure susceptibility, severity, and mortality were evaluated. Serial Morris water maze test and hippocampal histopathology results were examined before and 24 h after SE. Tetanic stimulation-induced long-term potentiation (LTP) in a hippocampal slice was recorded in a multi-electrode dish system. We also used a simulation model to evaluate intracellular adenosine triphosphate (ATP) and neuroexcitability. The STZ + SE group had a significantly higher percentage of severe seizures and SE-related death and worse learning and memory performances than the other three groups 24 h after SE. The STZ + SE group, and then the NS + SE group, showed the most severe neuronal loss and mossy fiber sprouting in the hippocampal CA3 area. In addition, LTP was markedly attenuated in the STZ + SE group, and then the NS + SE group. In the simulation, increased intracellular ATP concentration promoted action potential firing. This finding that rats with DH had more brain damage after SE than rats without diabetes suggests the importance of intensively treating hyperglycemia and seizures in diabetic patients with epilepsy. Notes This work was partly supported by grants from the National Science Council (NSC-96-2314-B-006-059) and National Cheng Kung University Hospital (NCKUH-2007-023 and Continue reading >>

Can High Blood Sugar (hyperglycemia) Cause Seizures?

Can High Blood Sugar (hyperglycemia) Cause Seizures?

Seizures can be triggered by too low blood sugar (hypoglycemia) and maybe by too high blood sugar (hyperglycemia). But overall, they are commonly linked with a condition called epilepsy. Furthermore, they also can be a warning sign of other health conditions. What else you need to know about the truth of seizures and hyperglycemia? Seizure – what actually is it? To control the movement of your body, your brain needs to send some small electrical signals around the body. For this mechanism, your body is equipped with a lot of nerves – these nerves acts as carrier for those signals. Theoretically, seizure occurs when the brain sends abnormal /wrong signals which then eventually can affect the way of the body’s function. Epilepsy is the most popular problem of nervous system that often linked with seizure. And it can affect people of all ages. But as written before, epilepsy is not the single reason of this symptom. The following are other health conditions that also can be potential to cause seizure: Toxoplasmosis or tapeworm (this is a kind of parasitic infection). Encephalitis or meningitis sometime also can trigger seizures. Certain health conditions that have developed since birth (connatural problems)! Imbalance glucose of bloodstream (particularly such as hypoglycemia /too low blood glucose). Aneurysm (a kind of structural defect that occurs in the brain). Problems that damage to the brain such as an injury of head, brain tumor, brain surgery, and stroke. In addition – an extremely fiver (especially if it occurs rapidly) and withdrawals of illegal drugs, certain prescription medications, or even abusing alcohol may also trigger and cause seizure. Can hyperglycemia or high blood sugar cause seizures? It is clear that hypoglycemia or too low blood sugar can be Continue reading >>

Focal Seizures As A First Manifestation Of Nonketotic Hyperglycemia

Focal Seizures As A First Manifestation Of Nonketotic Hyperglycemia

I report two elderly females who developed repetitive focal seizures as their first manifestations of nonketotic hyperglycemia In the second patient, the seizures were constantly induced by active or passive movements of the involved arm. With a control of the hyperglycemia, the seizures stopped in both cases. Contrary to previous reports, the focal seizures of the second case seemed to respond to parenteral administration of phenytoin. Continue reading >>

Case Report Nonketotic Hyperglycemia-related Epileptic Seizures

Case Report Nonketotic Hyperglycemia-related Epileptic Seizures

1. Introduction Seizures related to head trauma are often encountered in clinical practice, and some of them combine with nonketotic hyperglycemia (NKH) and variable hyperosmolarity. However, seizures related to nonketotic hyperglycemia (NKH) are rare in clinical practice. Because epileptic seizures related to NKH significantly affect neurological outcomes [1] and may cause misdiagnosis or missed diagnosis, more attention should be paid to them. In this manuscript, we report a case of NKH-related seizures. 2. Case presentation A 49-year-old male patient, without a known history of diabetes, was hospitalized because of a head trauma. Cranial CT scan showed mild subarachnoid hemorrhage without definite significance. On admission, his glucose and serum electrolyte levels were normal. Three days later, he developed partial seizures that began in his face. The average duration of the seizures in each episode was 4 min (range: 1–5 min, with one seizure lasting for 10 min) and could not be controlled by antiepileptic drugs. At the same time, his average plasma glucose level was 18.32 mmol/L (range: 15–24 mmol/L, normal range: 3.9–6.1 mmol/L), and his serum electrolyte levels were normal. When the seizures stopped, his average plasma glucose level decreased to 8.3 mmol/L (range: 4.7–11.2 mmol/L, normal range: 3.9–6.1 mmol/L). He had no family history of epilepsy and denied a history of spontaneous seizures or hyperglycemia. Under the guidance of an endocrinologist, the patient's hyperglycemia was treated with intravenous fluids and insulin and the seizures resolved. He was discharged 10 days later. He remained seizure- and antiepileptic drug-free after discharge as of his 3-month follow-up. 3. Discussion Focal seizures induced by hyperglycemia were first reported in 1 Continue reading >>

Nonketotic Hyperglycemia-related Epileptic Seizures

Nonketotic Hyperglycemia-related Epileptic Seizures

Abstract To investigate nonketotic hyperglycemia (NKH)-related epileptic clinical features and pathogenesis, and improve the diagnosis and treatment. Clinical data, including the clinical manifestations, laboratory tests, imaging studies and other information, of 13 patients with hyperglycemia-related epilepsy in our department were retrospectively analyzed. Blood glucose levels of the 13 patients when admitted to the hospital ranged between 24.7-34.6 mmol/L (average 28.3 mmol/L), their plasma osmolality ranged between 290–332 mOsm/L (average 308 mOsm/L), and their ketone results were negative. Among them, seven had convulsions, 4 had upper limbs and facial twitching, and 2 had bust twitch. Imaging findings could not detect accountable lesions related to seizures. EEG mainly showed spikes, slow waves, and scattered sharp slow waves. Insulin combined short-term antiepileptic drugs, allowed the epilepsy to be effectively controlled without recurrence. Patients with episodes of NKH epilepsy increased significantly with hyperglycemia. Raising awareness of the disease, early diagnosis, and very early lowering the hyperglycemia levels, can effectively control the seizures. Lowering blood glucose is an effective way to control blood glucose levels. Material and methods This research has been approved by the ethics committee of the Second Hospital affiliated to Nantong University. Informed consent has been obtained and this investigation has been conducted according to the principles expressed in the Declaration of Helsinki. Thirteen cases of NKH-related epileptic seizures were treated from December 2009 to October 2014 in our neurosurgery department. Among them, 8 were males, and 5 females, aged 45–80 years old (mean age: 54 ± 2 years old). Their diabetes duration was bet Continue reading >>

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