Situation (hyperglycemia)-related non-convulsive status epilepticus detected by 1.5-Tesla arterial spin labeling perfusion imaging in a patient with newly diagnosed diabetes during a neurological emergency

Abstract

Situation-related non-convulsive status epilepticus (SR-NCSE) is a type of NCSE that is associated with various situations, including hyperglycemia. A 67-year-old woman with no prior history of type 2 diabetes mellitus visited our emergency room, experiencing difficulty typing on her mobile phone for approximately 2 h. Her blood glucose level was 334 mg/dL. 1.5-Tesla arterial spin labeling (ASL) perfusion magnetic resonance imaging, performed 40 min after her arrival, revealed presumed ictal hyperperfusion in the left parietal lobe. SR-NCSE associated with hyperglycemia was highly suspected, and she was immediately administered with insulin and antiseizure medications. The patient’s symptoms improved promptly. An electroencephalogram performed approximately 2 days later failed to reveal paroxysmal discharges. During neurological emergencies, ASL has the advantage of taking less time to perform than EEG, and we believe that ASL is useful in diagnosing SR–NCSE as well as structural focal NCSE when EEG cannot be performed.