levetiracetam and Hyperglycemia

We report the case of a 70-year-old diabetic woman who presented to the emergency department with multiple seizure episodes and coma, prompting the need for sedation and mechanical ventilation. She was transferred to our institution for neurosurgical evaluation as the initial CT scan identified hyperdense lesions in the left basal ganglia, interpreted as acute intracranial haemorrhage. On admission, laboratory tests were mostly normal except for blood glucose of 413 mg/dL. Medical records revealed a history of poorly controlled diabetes mellitus and non-adherence to therapy. After seizure control and lifting sedation, right-sided ataxia/involuntary movements were observed. Considering the patient's history and these findings, the CT scan was reviewed and the striatal region hyperdensities interpreted as lesions typical of non-ketotic hemichorea-hemiballismus. MRI was latter performed and confirmed the diagnosis, even though the unusual presentation. Levetiracetam initiation and glycaemic control optimisation led to great neurological improvement without seizure recurrence.

Topics: Aged; Anticonvulsants; Basal Ganglia; Blood Glucose; Coma; Diabetes Mellitus, Type 2; Diagnosis, Differential; Dyskinesias; Female; Humans; Hyperglycemia; Intracranial Hemorrhages; Levetiracetam; Magnetic Resonance Imaging; Medication Adherence; Seizures; Tomography, X-Ray Computed

Nonketotic hyperglycemia-related seizures are not uncommonly encountered in clinical practice. Their presentation varies, and they may cause serious consequences if they remain unnoticed.. We report a case of nonketotic hyperglycemia-related seizures of unique left parieto-occipital origin and semiology, presenting as focal aware (simple partial) and impaired awareness (complex partial) seizures, including contralateral limb convulsion and apraxialike behavior.. Nonketotic hyperglycemia-related seizures can present with a relatively unique semiology. Careful education to the patients and family regarding attention to the paroxysmal symptoms and an effort to maintain good glycemic control are mandatory in clinical practice.

Topics: Administration, Intravenous; Electroencephalography; Female; Humans; Hyperglycemia; Insulin; Levetiracetam; Magnetic Resonance Imaging; Middle Aged; Neuroscience Nursing; Occipital Lobe; Paresis; Parietal Lobe; Seizures