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Hyperosmolar hyperglycaemic state causing atypical status epilepticus with hippocampal involvement
  1. Emanuele Bartolini1,
  2. Raffaella Valenti1,
  3. Josemir W Sander2,3
  1. 1 Neurology Unit, Nuovo Ospedale Santo Stefano, USL Tuscany Center, Prato, Italy
  2. 2 Chalfont Centre for Epilepsy, London, UK
  3. 3 UCL Queen Square Institute of Neurology, NIHR University College London Hospitals Biomedical Research Centre, London, UK
  1. Correspondence to Dr Emanuele Bartolini, Neurology Unit, Nuovo Ospedale Santo Stefano, USL Tuscany Center, Prato, Italy; emanuelebartolini{at}


Diabetes mellitus may arise abruptly and decompensate suddenly, leading to a hyperglycaemic hyperosmolar state. Coma often ensues, although this usually reverses after the metabolic abnormalities have resolved. Acute symptomatic seizures can also occur in patients who are conscious, although these usually resolve after osmolarity and glycaemia have normalised. We describe an elderly woman who failed to regain vigilance despite prompt treatment; the cause was an unusual non-convulsive status epilepticus arising from the mesial temporal lobe and promoting a progressive and selective hippocampal involvement. During follow-up, her seizures recurred after stopping antiseizure medication and she developed hippocampal sclerosis, although she subsequently became seizure-free with antiseizure medications. Patients who are unresponsive in a hyperglycaemic hyperosmolar state may be having subclinical epileptiform discharges and risk developing permanent brain damage and long-term epilepsy.

  • epilepsy
  • diabetes mellitus
  • MRI

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  • Contributors EB and RV clinically managed the individual. All authors were involved in conceptualising the report. RV and JWS edited the manuscript. All reviewed and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned. Externally peer reviewed by Sofia Eriksson, London, UK.

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