Spectrum of hyperosmolar hyperglycaemic state in neurology practice

Abstract

Background & objectives: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.Methods: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.Results: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.Interpretation & conclusions: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.

Multicentre analysis of hyperglycaemic hyperosmolar state and diabetic ketoacidosis in type 1 and type 2 diabetes

“…Both DKA and HHS occurred more often in paediatric T1D patients at diagnosis and during follow-up. Among all subjects with HHS, 19.2% were not previously diagnosed with diabetes which is comparable with previous findings [8]. DKA at diagnosis was present in almost every fifth paediatric patient with T1D, also comparable with previous results [5].…”

“…Adult T1D or T2D patients with HHS during follow-up were older. One reason might be reduced fluid intake of older patients [30] or the fact that older people often have more comorbidities [31], which makes diabetes treatment more complicated, especially during sick days [8,10]. T2D patients with a more severe diabetes are more likely to be treated with insulin [32], and more severe diabetes can lead to decompensation.…”

“…The online version of this article (https ://doi.org/10.1007/s0059 2-020-01538 -0) contains supplementary material, which is available to authorized users. risk factor for HHS is infection, followed by neurological sequelae, as well as myocardial infarction which may lead to severe dehydration [8,10].…”

“…Mortality ranges from 5 to 20%, which is about 10 times higher compared with DKA, due to higher age or delayed diagnosis [4][5][6]. Previous studies reported higher occurrence of HHS in females and older patients (60 + years) and at diabetes onset [7][8][9]. The most common Managed by Massimo Federici.…”

A Rare Case of Hemichorea-Hemiballismus Due to Chronic Uncontrolled Hyperglycemia

“…The possible association between non-ketotic hyperglycemia and focal neurological deficits, such as choreoathetosis and ballismus, was first delineated in 1960. Surprisingly, this association is more prevalent in Asian women suggesting some genetic components might be involved in such association [1][2]. Hemiballism is characterized by irregular, coarse, fierce, flinging movements of the limbs particularly due to the contraction of proximal muscles while chorea presents as continuous, random, jerking movements involving both proximal and distal muscles [3].…”