Abstract
A 75-year-old woman with dimentia hospitalized for sustained myoclonic seizure with disturbed consciousness and hyperglycemia had been demented 4 years and diabetic 2years. Physical examination showed a deeply comatose, markedly dehydrated woman with pendular nystagmus. Several diabetic bullae were noted on her skin. Serum chemistry was sodium 173 mEq/l, plasma glucose 545 mg/dl, and HbA1c 10.6%. Urine was negative for ketone bodies. Arterial blood pH was 7.463. The clinical diagnosis was nonketotic hyperosmolar diabetic coma. She did not recover consciousness even after serum sodium was decreased with fluid and insulin infusion. Brain computed tomography (CT) showed marked cerebral edema on hospital day 4, followed by a large infarct with hemorrhage in the left hemisphere on hospital day 11. Sagittal sinus thrombosis was diagnosed on hospital day16. Due to the large cerebral infarct, she remained unconscious even after brain edema gradually subsided. To the best of our knowledge, this is the first case report of deep cerebral venous thrombosis complicated by a nonketotic hyperosmolar state. Chronic hemoconcentration secondary to poorly controlled diabetes appeared to be a predisposing factor in the unusual comorbidity in this case.
