# October 2020

- Link: https://isnr.in/october-2020/
- Published: 2020-10-31T00:00:00+05:30
- Author: ISNR

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⌉⌊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.