{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T17:39:21Z","timestamp":1793381961883,"version":"4.5.0"},"reference-count":24,"publisher":"Scientific Scholar","issue":"Suppl 2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2017,11]]},"abstract":"\n Background & objectives:<\/jats:title>\n Hyperosmolar hyperglycaemic state (HHS) is a medical emergency, but there is a paucity of studies reporting the spectrum of neurological manifestations of HHS. We, therefore, report the neurological spectrum, triggering factors and outcome of HHS in general neurology practice.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n The records of the patients with HHS were extracted from computerized hospital information system and those managed currently were prospectively included. The demographic, clinical manifestations, duration of diabetes and precipitating events such as infection, stress and stroke were noted. Patients with HHS were categorized into seizure, movement disorder and encephalopathy groups. Their electroencephalography, magnetic resonance imaging (MRI) findings and outcome were noted.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n There were 17 patients with HHS (age range 40 and 75 yr) and seven were females. Seven patients were diabetic for five years, one for four years, one for one year and four were diagnosed after the occurrence of HHS. Four patients had epilepsia partialis continua persisting for 72-360 h, one patient had focal seizures and his MRI revealed T2 hyperintensity in frontal region in one patient and cerebellar vermian hyperintensity in another. All the five patients improved, but two had neurological deficits on discharge. Nine patients had encephalopathy which was precipitated by stroke in six patients, urinary infections in two and meningitis in one. Three females had hemichorea-hemiballismus syndrome, which was triggered by infections. Abnormal movements lasted 5-10 days and responded to correction of hyperosmolarity. Nine out of 17 patients improved completely whereas the remaining eight had partial recovery, these patients had stroke, ventilator-related complications or meningoencephalitis.<\/jats:p>\n <\/jats:sec>\n \n Interpretation & conclusions:<\/jats:title>\n The most common presentation of HHS was encephalopathy (9) followed by seizure (5) and hemichorea-hemiballismus syndrome (3) which responded to the correction of hyperosmolar state.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/ijmr.ijmr_57_15","type":"journal-article","created":{"date-parts":[[2018,3,26]],"date-time":"2018-03-26T05:40:17Z","timestamp":1522042817000},"page":"S1-S7","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":28,"title":["Spectrum of hyperosmolar hyperglycaemic state in neurology practice"],"prefix":"10.25259","volume":"146","author":[{"given":"U.K.","family":"Misra","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Kalita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.K.","family":"Bhoi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Dubey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","reference":[{"key":"R1-1-20241212","first-page":"1","article-title":"About sudden death and coma in diabetes","volume":"6","author":"Frerichs","year":"1883","journal-title":"Z Klin Med (Berlin"},{"key":"R2-1-20241212","first-page":"893","article-title":"Severe diabetic stupor without ketosis","volume":"31","author":"Sament","year":"1957","journal-title":"S Afr Med J"},{"key":"R3-1-20241212","doi-asserted-by":"crossref","first-page":"28","DOI":"10.2337\/diaspect.15.1.28","article-title":"Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome","volume":"15","author":"Umpierrez","year":"2002","journal-title":"Diabetes Spectr"},{"key":"R4-1-20241212","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.diabres.2011.06.018","article-title":"Characteristics and outcomes of the hyperglycemic hyperosmolar non-ketotic syndrome in a cohort of 51 consecutive cases at a single center","volume":"94","author":"Fadini","year":"2011","journal-title":"Diabetes Res Clin Pract"},{"key":"R5-1-20241212","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1002\/ana.410080205","article-title":"Epilepsia partialis continua associated with nonketotic hyperglycemia: Clinical and biochemical profile of 21 patients","volume":"8","author":"Singh","year":"1980","journal-title":"Ann Neurol"},{"key":"R6-1-20241212","first-page":"165","article-title":"Continuous partial epilepsy (Kozhevnikov epilepsy)","volume":"42","author":"L\u00f6hler","year":"1974","journal-title":"Fortschr Neurol Psychiatr Grenzgeb"},{"key":"R8-1-20241212","first-page":"975","article-title":"Unilateral putaminal CT, MR, and diffusion abnormalities secondary to nonketotic hyperglycemia in the setting of acute neurologic symptoms mimicking stroke","volume":"25","author":"Wintermark","year":"2004","journal-title":"AJNR Am J Neuroradiol"},{"key":"R9-1-20241212","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1097\/00004728-200211000-00009","article-title":"Hemichorea-hemiballism in primary diabetic patients: MR correlation","volume":"26","author":"Lee","year":"2002","journal-title":"J Comput Assist Tomogr"},{"key":"R10-1-20241212","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1136\/jnnp.2005.067033","article-title":"Acanthocytosis as a predisposing factor for non-ketotic hyperglycaemia induced chorea-ballism","volume":"76","author":"Pisani","year":"2005","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"R11-1-20241212","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1212\/WNL.10.6.619","article-title":"Some observations on hemiballismus","volume":"10","author":"Bedwell","year":"1960","journal-title":"Neurology"},{"key":"R12-1-20241212","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/S0022-510X(02)00133-8","article-title":"Chorea associated with non-ketotic hyperglycemia and hyperintensity basal ganglia lesion on T1-weighted brain MRI study: A meta-analysis of 53 cases including four present cases","volume":"200","author":"Oh","year":"2002","journal-title":"J Neurol Sci"},{"key":"R13-1-20241212","first-page":"239","article-title":"Continuous partial epilepsy disclosing diabetes mellitus","volume":"150","author":"Cochin","year":"1994","journal-title":"Rev Neurol (Paris"},{"key":"R14-1-20241212","doi-asserted-by":"crossref","first-page":"2739","DOI":"10.2337\/dc06-9916","article-title":"Hyperglycemic crises in adult patients with diabetes: A consensus statement from the American Diabetes Association","volume":"29","author":"Kitabchi","year":"2006","journal-title":"Diabetes Care"},{"key":"R15-1-20241212","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1136\/jnnp.55.3.195","article-title":"Focal seizures and non-ketotic hyperglycaemia","volume":"55","author":"Hennis","year":"1992","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"R16-1-20241212","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1590\/S0004-282X1991000400013","article-title":"Partial motor seizures induced by movement in diabetic patients","volume":"49","author":"Tedrus","year":"1991","journal-title":"Arq Neuropsiquiatr"},{"key":"R17-1-20241212","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1684\/j.1950-6945.1999.tb00321.x","article-title":"SPECT findings in reflex seizures induced by movement in non-ketotic hyperglycemia","volume":"1","author":"Su\u00e1rez-Moro","year":"1999","journal-title":"Epileptic Disord"},{"key":"R18-1-20241212","doi-asserted-by":"crossref","first-page":"796","DOI":"10.3181\/00379727-97-23883","article-title":"Some metabolic studies of gamma-aminobutyric acid","volume":"97","author":"Roberts","year":"1958","journal-title":"Proc Soc Exp Biol Med"},{"key":"R19-1-20241212","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1016\/0026-0495(75)90146-8","article-title":"Neurologic manifestations of diabetic comas: Correlation with biochemical alterations in the brain","volume":"24","author":"Guisado","year":"1975","journal-title":"Metabolism"},{"key":"R20-1-20241212","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/0006-8993(95)01077-7","article-title":"Decreased cerebral blood flow during acute hyperglycemia","volume":"703","author":"Duckrow","year":"1995","journal-title":"Brain Res"},{"key":"R21-1-20241212","first-page":"125","article-title":"Diabetes mellitus and blood-brain barrier dysfunction: An overview","volume":"2","author":"Prasad","year":"2014","journal-title":"J Pharmacovigil"},{"key":"R22-1-20241212","first-page":"83","article-title":"Factors contributing to alteration in the level of consciousness in the patients with diabetic ketoacidosis: Analysis of 189 cases","volume":"13","author":"Pishdad","year":"1999","journal-title":"Med J Islam Repub Iran"},{"key":"R23-1-20241212","doi-asserted-by":"crossref","first-page":"S94","DOI":"10.2337\/diacare.27.2007.S94","article-title":"Hyperglycemic crises in diabetes","volume":"27","author":"Kitabchi","year":"2004","journal-title":"Diabetes Care"},{"key":"R24-1-20241212","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1210\/jc.2007-2577","article-title":"Thirty years of personal experience in hyperglycemic crises: Diabetic ketoacidosis and hyperglycemic hyperosmolar state","volume":"93","author":"Kitabchi","year":"2008","journal-title":"J Clin Endocrinol Metab"},{"key":"R25-1-20241212","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/S1059-1311(02)00353-9","article-title":"Seizures in nonketotic hyperglycaemia","volume":"12","author":"Tiamkao","year":"2003","journal-title":"Seizure"}],"container-title":["Indian Journal of Medical Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/02223309-201746002-00001","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T22:59:46Z","timestamp":1751497186000},"score":1,"resource":{"primary":{"URL":"https:\/\/ijmr.org.in\/spectrum-of-hyperosmolar-hyperglycaemic-state-in-neurology-practice\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11]]},"references-count":24,"journal-issue":{"issue":"Suppl 2","published-print":{"date-parts":[[2017]]}},"URL":"https:\/\/doi.org\/10.4103\/ijmr.ijmr_57_15","relation":{},"ISSN":["0971-5916"],"issn-type":[{"value":"0971-5916","type":"print"}],"subject":[],"published":{"date-parts":[[2017,11]]}}}