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American Journal of Medical Case Reports. 2020, 8(12), 463-466
DOI: 10.12691/AJMCR-8-12-8
Case Report

Left Homonymous Hemianopia: An Uncommon, Neuro-ophthalmological Presentation of Hyperglycemic Hyperosmolar State

Daniel Kashani1, Ganesh K Thirunavukkarasu1, Saeed Javidi2, Leonel Mendoza1 and Isabel M McFarlane1,

1Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA

2Department of Ophthalmology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA

Pub. Date: September 03, 2020
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Cite this paper

Daniel Kashani, Ganesh K Thirunavukkarasu, Saeed Javidi, Leonel Mendoza and Isabel M McFarlane. Left Homonymous Hemianopia: An Uncommon, Neuro-ophthalmological Presentation of Hyperglycemic Hyperosmolar State. American Journal of Medical Case Reports. 2020; 8(12):463-466. doi: 10.12691/AJMCR-8-12-8

Abstract

Spectrum of the neurological deficits in non-ketotic hyperglycemia and hyperosmolar hyperglycemic state (HHS) ranges widely among patients and can have any presentation from focal seizures, epilepsia partialis continua, chorea-hemiballismus syndrome, hemiparesis, hemianopia to mental obtundation and coma. Here we report a case of HHS which presented with Left Homonymous Hemianopia as the only initial presentation. Symptoms slowly resolved over the course of two weeks by administration of insulin and normalizing the glucose.

Keywords

Homonymous Hemianopia, hyperosmolar hyperglycemic state, seizure, insulin

Copyright

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]  Goodwin D. Homonymous hemianopia: challenges and solutions. Clin Ophthalmol. 2014; 8: 1919-1927. Published 2014 Sep 22.
 
[2]  Strowd RE, Wabnitz A, Balakrishnan N, Craig J, Tegeler CH. Clinical reasoning: acute-onset homonymous hemianopia with hyperglycemia: seeing is believing. Neurology. 2014; 82(15): e129‐e133.
 
[3]  Mizuguchi C, Sato Y, Imai H, Kakizawa M, Yamashita K, Aizawa T. Homonymous quadrantanopia associated with hyperosmolar hyperglycemic syndrome [published online ahead of print, 2020 Mar 25]. J Diabetes Investig. 2020.
 
[4]  van Raamt AF, Mali WP, van Laar PJ, van der Graaf Y. The fetal variant of the circle of Willis and its influence on the cerebral collateral circulation. Cerebrovasc Dis. 2006; 22(4): 217-224.
 
[5]  Wu HM, Chuang YM. The clinical relevance of fetal variant of the circle of Willis and its influence on the cerebral collateral circulation. Acta Neurol Taiwan. 2011; 20(4): 232-242.
 
[6]  Stayman A, Abou-Khalil BW, Lavin P, Azar NJ. Homonymous hemianopia in nonketotic hyperglycemia is an ictal phenomenon. Neurol Clin Pract. 2013; 3(5): 392‐397.
 
[7]  Kim DW, Moon Y, Gee Noh H, Choi JW, Oh J. Blood-brain barrier disruption is involved in seizure and hemianopsia in nonketotic hyperglycemia. Neurologist. 2011; 17(3): 164‐166.
 
[8]  Sasaki, F., Kawajiri, S., Nakajima, S. et al. Occipital lobe seizures and subcortical T2 and T2* hypointensity associated with nonketotic hyperglycemia: a case report. J Med Case Reports 10, 228 (2016).
 
[9]  Wan Q, Xiong ZG, Man HY, et al. Recruitment of functional GABA(A) receptors to postsynaptic domains by insulin. Nature. 1997; 388(6643): 686-690.
 
[10]  Trujeque-Ramos S, Castillo-Rolón D, Galarraga E, et al. Insulin Regulates GABAA Receptor-Mediated Tonic Currents in the Prefrontal Cortex. Front Neurosci. 2018; 12: 345.
 
[11]  Jin Z, Jin Y, Kumar-Mendu S, Degerman E, Groop L, Birnir B. Insulin reduces neuronal excitability by turning on GABA(A) channels that generate tonic current. PLoS One. 2011; 6(1): e16188.
 
[12]  Peng S, Yang J, Wang Y, et al. Low-dose intranasal insulin improves cognitive function and suppresses the development of epilepsy. Brain Res. 2020; 1726: 146474.
 
[13]  Freedman KA, Polepalle S. Transient homonymous hemianopia and positive visual phenomena in nonketotic hyperglycemic patients. Am J Ophthalmol. 2004; 137(6): 1122‐1124.
 
[14]  Misra UK, Kalita J, Bhoi SK, Dubey D. Spectrum of hyperosmolar hyperglycaemic state in neurology practice. Indian J Med Res. 2017 Nov; 146(Supplement):S1-S7. PMID: 29578188
 
[15]  Nissa Z, Siddiqi SA, Abdool SA. Occipital seizures and persistent homonymous hemianopia with T2 hypointensity on MRI in nonketotic hyperglycemia. Epilepsy Behav Case Rep. 2016; 6: 3‐5.
 
[16]  Gaballa S, Hlaing KM, Moursy S, Ahmed A, AlJaf A. Non-Ketotic Hyperglycemia Causing a Transient Unilateral Homonymous Hemianopia: A Manifestation of Occipital Lobe Seizure. Cureus. 2020; 12(6): e8527.
 
[17]  López-Amorós A, Medrano-Martínez V, Francés-Pont I, et al. Reversible Homonymous Inferior Quadrantanopia in a Nonketotic Hyperglycemic Patient. Neuroophthalmology. 2018; 44(1): 45-48.
 
[18]  Taban M, Naugle RI, Lee MS. Transient homonymous hemianopia and positive visual phenomena in patients with nonketotic hyperglycemia. Arch Ophthalmol. 2007; 125(6): 845-847.