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Acute stroke-like deficits associated with nonketotic hyperglycemic hyperosmolar state: an illustrative case and systematic review of literature

Title: Acute stroke-like deficits associated with nonketotic hyperglycemic hyperosmolar state: an illustrative case and systematic review of literature
Authors: Rossi, S
Romoli, M
Urbinati, G
Benini, M
Russo, M
D'Anna, L
Abu-Rumeileh, S
Sacco, S
Querzani, P
Foschi, M
Item Type: Journal Article
Abstract: INTRODUCTION: Nonketotic hyperglycemic hyperosmolar state (NKHHS) is associated with a wide spectrum of neurological syndromes including acute stroke-like deficits. Clinical features and etiology have not been established yet. METHODS: Here we provide a case illustration and systematic review on non-epileptic acute neurological deficits in NKHSS. The systematic literature search followed PRISMA guidelines and a predefined protocol, including cases of NKHSS with acute stroke-like presentation. RESULTS: The database search yielded 18 cases. Hemianopia was the most common clinical presentation (73%), followed by partial or total anterior circulation syndrome (26%). Patients with symptoms of acute anterior circulation infarct were significantly older (69.5 ± 5.1 vs. 52.2 ± 13.9 years; p = 0.03) and showed higher mean glucose levels at the admission vs. those with hemianopia (674.8 ± 197.2 vs. 529.4 ± 190.8 mg/dL; p = 0.16). Brain MRI was performed in 89% of patients, resulting abnormal in 71% of them, especially hemianopic (91%). Subcortical hypointensities in T2-FLAIR MR sequences were present in all the analyzed cases. Cortical DWI hyperintensities were also common (64%). EEG showed diffuse or focal slow wave activity in 68% of patients, especially with visual hallucinations (85%). Neurological symptoms completely resolved in 78% of patients within 6 (IQR 3-10) days, following aggressive treatment and glucose normalization. CONCLUSIONS: Our results suggest neuronal dysfunction on a metabolic basis as the leading cause of acute neurological deficits in NKHHS. Despite the generally favorable prognosis, prompt identification and aggressive treatment are crucial to avoid irreversible damage. Larger cohort studies are needed to confirm our findings.
Issue Date: 1-Aug-2022
Date of Acceptance: 18-Apr-2022
URI: http://hdl.handle.net/10044/1/100125
DOI: 10.1007/s10072-022-06088-7
ISSN: 1590-1874
Publisher: Springer
Start Page: 4671
End Page: 4683
Journal / Book Title: Neurological Sciences
Volume: 43
Issue: 8
Copyright Statement: © The Author(s) 2022. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Keywords: Hyperglycemia
Hyperosmolarity
Neurological deficits
Nonketotic hyperglycemic hyperosmolar state
Stroke
Stroke mimic
Glucose
Hemianopsia
Humans
Hyperglycemic Hyperosmolar Nonketotic Coma
Stroke
Syndrome
Humans
Hemianopsia
Hyperglycemic Hyperosmolar Nonketotic Coma
Syndrome
Glucose
Stroke
Hyperglycemia
Hyperosmolarity
Neurological deficits
Nonketotic hyperglycemic hyperosmolar state
Stroke
Stroke mimic
Glucose
Hemianopsia
Humans
Hyperglycemic Hyperosmolar Nonketotic Coma
Stroke
Syndrome
Neurology & Neurosurgery
1103 Clinical Sciences
1109 Neurosciences
Publication Status: Published
Conference Place: Italy
Online Publication Date: 2022-04-28
Appears in Collections:Department of Brain Sciences



This item is licensed under a Creative Commons License Creative Commons