October 2020

An elderly male, known diabetic with one episode of seizure. What is the diagnosis?

Case contributed by –

Department of Imaging Sciences and Intervention Radiology, SCTIMST, Trivandrum (from ISNR 2020 online quiz)

Case of the Month October 2020

FLAIR shows cortical hyperintense signal in left temporal lobe. Subcortical hypointense signals are seen in T2-w images. No diffusion restriction is seen. ASL shows hyperperfusion.

Final diagnosis – Seizures associated with non- ketotic hyperglycaemia (NKH)

  • Non-ketotic hyperglycemia (NKH) -triad of severe hyperglycemia, hyperosmolarity, and intracellular dehydration without ketoacidosis.
  • 15–40% of patients with NKH can present with seizures.
  • Cortical hyperintense signal changes with/without diffusion restriction and reversible sub-cortical hypointense signal changes are the MR imaging features.
  • ASL hyperperfusion secondary to hyperglycemia-induced increased blood-brain barrier permeability and may remain persist for longer duration.

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