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Transient Homonymous Superior Quadrantanopsia in Nonketotic Hyperglycemia: A Case Report and Systematic Review

Journal of Clinical Neurology 2020년 16권 4호 p.599 ~ 604
Lee Sun-Uk, Lee Jung-Yeun, 윤지은, 김효정, 최정윤, 윤창호, 김지수,
소속 상세정보
 ( Lee Sun-Uk ) - Korea University Medical Center Department of Neurology
 ( Lee Jung-Yeun ) - Korea University Medical Center Department of Neurology
윤지은 ( Yoon Jee-Eun ) - Seoul National University Bundang Hospital Department of Neurology
김효정 ( Kim Hyo-Jung ) - Seoul National University Bundang Hospital Research Administration Team
최정윤 ( Choi Jeong-Yoon ) - Seoul National University Bundang Hospital Department of Neurology
윤창호 ( Yun Chang-Ho ) - Seoul National University Bundang Hospital Department of Neurology
김지수 ( Kim Ji-Soo ) - Seoul National University College of Medicine Department of Neurology

Abstract


Background and Purpose: Nonketotic hyperglycemia often causes transient visual field defects, but only scattered anecdotes are available in the literature.

Methods: We report a patient with homonymous superior quadrantanopsia due to nonketotic hyperglycemia and provide a systematic literature review of the clinical features of 40 previously reported patients (41 in total, including our case) with homonymous visual field defects in association with nonketotic hyperglycemia.

Results: The typical visual field defect was congruous (84.6%), homonymous hemianopsia (87.8%) with macular splitting (61.5%) or sparing (38.5%). It was transient and repetitive in 54.5% of the patients, but it developed as a persistent form in the remainder. Positive visual symptoms such as hallucinations and phosphenes developed in 73.2% of patients. Brain MRI revealed corresponding abnormalities in most patients (84.8%), characterized by a low-intensity white-matter signal or a high-intensity gray-matter signal on T2-weighted or fluid-attenuated inversion recovery images with diffusion restriction or gadolinium enhancement. Most (97.0%) patients recovered completely, with 48.5% treated by glycemic control alone and the remainder also receiving antiepileptic agents.

Conclusions: Nonketotic hyperglycemia should be considered a possible cause of transient visual field defects, especially when it is associated with repetitive positive visual symptoms and typical MRI findings in hyperglycemic patients.

키워드

visual fields; quadrantanopsia; hyperglycemia; diabetes mellitus

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