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Hyperosmolar hyperglycaemic state causing atypical status epilepticus with hippocampal involvement

Bartolini, E; Valenti, R; Sander, JW; (2021) Hyperosmolar hyperglycaemic state causing atypical status epilepticus with hippocampal involvement. Practical Neurology 10.1136/practneurol-2021-003222. (In press). Green open access

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Abstract

Diabetes mellitus may arise abruptly and decompensate suddenly, leading to a hyperglycaemic hyperosmolar state. Coma often ensues, although this usually reverses after the metabolic abnormalities have resolved. Acute symptomatic seizures can also occur in patients who are conscious, although these usually resolve after osmolarity and glycaemia have normalised. We describe an elderly woman who failed to regain vigilance despite prompt treatment; the cause was an unusual non-convulsive status epilepticus arising from the mesial temporal lobe and promoting a progressive and selective hippocampal involvement. During follow-up, her seizures recurred after stopping antiseizure medication and she developed hippocampal sclerosis, although she subsequently became seizure-free with antiseizure medications. Patients who are unresponsive in a hyperglycaemic hyperosmolar state may be having subclinical epileptiform discharges and risk developing permanent brain damage and long-term epilepsy.

Type: Article
Title: Hyperosmolar hyperglycaemic state causing atypical status epilepticus with hippocampal involvement
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1136/practneurol-2021-003222
Publisher version: http://dx.doi.org/10.1136/practneurol-2021-003222
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: MRI, diabetes mellitus, epilepsy
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Clinical and Experimental Epilepsy
URI: https://discovery.ucl.ac.uk/id/eprint/10140713
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