Reversible Visual and Neurological Manifestations of Nonketotic Hyperglycemia: A Case Report

Abstract

Nonketotic hyperglycemia (NKH) has been associated with visual field and neurological alterations, typically reversible with glycemic control.

A 54-year-old woman with hypertension and dyslipidemia presented in the emergency department with a 2-week history of headaches, left visual field photopsia and polydipsia and polyuria. Examination revealed homonymous left hemianopia, along with brief episodes of head and eye deviation to the left, consistent with focal epileptic seizures originating in the right hemisphere, later confirmed by electroencephalogram. Ophthalmologic exams ruled out ocular alterations, while lab results showed hyperglycemia with normal pH, excluding infections and autoimmune causes. Magnetic resonance imaging (MRI) revealed right occipital lobe changes consistent with a postictal state. With glycemic normalization and antiepileptic treatment, her visual symptoms and seizures resolved. After two months, she remained asymptomatic, and her MRI was normal.

This case demonstrates that NKH can cause reversible visual and neurological symptoms, including specific MRI findings, underscoring the importance of recognizing these manifestations for timely diagnosis and treatment.