Reversible Magnetic Resonance Imaging Abnormality in A Case of Diabetic Hyperglycemia related Epilepsia Partialis Continua

糖尿病高血糖合併局部持續性癲癇造成可逆性腦部核磁共振影像變化－病例報告

林文守(Wen-Sou Lin) ； 高鴻文(Hung-Wen Kao) ； 宋岳峰(Yueh-Feng Sung)

《內科學誌》 22卷6期 (2011/12) Pp. 438-443

https://doi.org/10.6314/JIMT.2011.22(6).08

摘要

糖尿病合併癲癇症在臨床並不少見，但大部分病人出現癲癇併發症的時間很短，影像學上多無特異發現，臨床上也不需使用抗癲癇藥物治療。我們報告一位72歲新診斷的糖尿病患者，以局部持續性癲癇發作來表現，且時間已長達一個月。腦部核磁共振影像出現罕見且獨特之異常變化。住院後病人血糖雖然控制良好，但仍持續有癲癇發作現象。於是開始給予抗癲癇藥物治療，使用數天後癲癇即有效獲得控制。後續追蹤之核磁共振影像顯示原本異常之訊號已完全恢復正常。我們建議爾後如有糖尿病患者合併類似之核磁共振影像異常時，除了積極控制血糖外，提早且短期的使用抗癲癇藥物也許有助於更快速地控制此類患者之癲癇症狀。

並列摘要

Seizure can be the first symptom of diabetic hyperglycemia and cause transient abnormalities in neuroimaging studies. Herein, we report the case of a 72-year-old woman with a one-month history of intermittent clonic movement of the left upper limb and neck. Laboratory testing revealed non-ketotic hyperglycemia. Electroencephalography showed asymmetrical background with delta activity over right frontal-temporal lobe. Brain magnetic resonance imaging revealed leptomeningeal and cortical enhancement in the right parieto-occipital area with T2 hypointensity in the corresponding subcortical area, a finding which has been rarely reported. She was treated successfully with oral hypoglycemic agents and short-term use of valproic acid. Follow-up brain magnetic resonance imaging three months later showed total recovery of the signal changes with residual mild cortical atrophy in the same region. For patients with diabetic hyperglycemia and prolonged seizures which results in abnormalities of brain imaging consistent with leptomeningeal and cortical enhancement, valproic acid may be beneficial in abolishing the seizures. (J Intern Med Taiwan 2011; 22: 438-443)

並列關鍵字

Diabetic hyperglycemia ； Epilepsia partialis continua ； Magnetic resonance imaging ； Valproic acid