{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T17:00:58Z","timestamp":1777568458979,"version":"3.51.4"},"reference-count":9,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Pract Neurol"],"accepted":{"date-parts":[[2021,11,23]]},"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1136\/practneurol-2021-003222","type":"journal-article","created":{"date-parts":[[2021,12,13]],"date-time":"2021-12-13T13:25:20Z","timestamp":1639401920000},"page":"117-119","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Hyperosmolar hyperglycaemic state causing atypical status epilepticus with hippocampal involvement"],"prefix":"10.1136","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5683-1941","authenticated-orcid":false,"given":"Emanuele","family":"Bartolini","sequence":"first","affiliation":[{"name":"Neurology Unit, Nuovo Ospedale Santo Stefano, USL Tuscany Center, Prato, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raffaella","family":"Valenti","sequence":"additional","affiliation":[{"name":"Neurology Unit, Nuovo Ospedale Santo Stefano, USL Tuscany Center, Prato, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6041-9661","authenticated-orcid":false,"given":"Josemir W","family":"Sander","sequence":"additional","affiliation":[{"name":"Chalfont Centre for Epilepsy, London, UK"},{"name":"UCL Queen Square Institute of Neurology, NIHR University College London Hospitals Biomedical Research Centre, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,12,13]]},"reference":[{"key":"2025090409351206000_22.2.117.1","doi-asserted-by":"publisher","DOI":"10.1016\/S1059-1311(02)00353-9"},{"key":"2025090409351206000_22.2.117.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2008.12.001"},{"key":"2025090409351206000_22.2.117.3","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1016\/j.yebeh.2007.03.001","article-title":"Nonconvulsive status epilepticus manifesting as pure alexia (alexia without agraphia)","volume":"10","author":"Kutluay","year":"2007","journal-title":"Epilepsy Behav"},{"key":"2025090409351206000_22.2.117.4","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1684\/epd.2011.0425","article-title":"Non-convulsive status epilepticus characterised exclusively by a language disorder induced by non-ketotic hyperglycaemia","volume":"13","author":"Pro","year":"2011","journal-title":"Epileptic Disord"},{"key":"2025090409351206000_22.2.117.5","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1007\/s00234-020-02408-w","article-title":"\"Negative T2 shine through\" in patients with hyperglycemia and seizures: a frequently overlooked MRI pattern","volume":"62","author":"Urbach","year":"2020","journal-title":"Neuroradiology"},{"key":"2025090409351206000_22.2.117.6","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1111\/epi.14493","article-title":"Neuroimaging alterations related to status epilepticus in an adult population: definition of MRI findings and clinical-EEG correlation","volume":"59 Suppl 2","author":"Giovannini","year":"2018","journal-title":"Epilepsia"},{"key":"2025090409351206000_22.2.117.7","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1016\/j.yebeh.2009.10.005","article-title":"Status epilepticus with visual seizures in ketotic hyperglycemia","volume":"16","author":"Mart\u00ednez-Fern\u00e1ndez","year":"2009","journal-title":"Epilepsy Behav"},{"key":"2025090409351206000_22.2.117.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2015.05.017"},{"key":"2025090409351206000_22.2.117.9","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1038\/s41582-020-0359-x","article-title":"GAD antibodies in neurological disorders - insights and challenges","volume":"16","author":"Graus","year":"2020","journal-title":"Nat Rev Neurol"}],"container-title":["Practical Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/practneurol-2021-003222","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T16:35:17Z","timestamp":1757003717000},"score":1,"resource":{"primary":{"URL":"https:\/\/pn.bmj.com\/lookup\/doi\/10.1136\/practneurol-2021-003222"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,13]]},"references-count":9,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,3,17]]},"published-print":{"date-parts":[[2022,4]]}},"alternative-id":["10.1136\/practneurol-2021-003222"],"URL":"https:\/\/doi.org\/10.1136\/practneurol-2021-003222","relation":{},"ISSN":["1474-7758","1474-7766"],"issn-type":[{"value":"1474-7758","type":"print"},{"value":"1474-7766","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,13]]}}}