Isolated Aphasic Status Epilepticus as a Manifestation Induced by Hyperglycemia Without Ketosis

Diagnosis of aphasic status epilepticus (ASE) is very difficult, because the literature containing, to our knowledge, isolated non-ketotic hyperglycemia (NKH)-related ASE has reported only three cases. Although most cases are associated with organic brain lesions accompanying other clinical seizure activity, NKH-related ASE is rarer. We describe a rare case of NKH presenting initially as persistent and isolated ASE. Brain magnetic resonance imaging (MRI) did not reveal any focal lesion, but ictal electroencephalography (EEG) disclosed diffuse continuous theta to delta waves, intermingled with epileptiform discharges. Only correcting the hyperglycemia could not improve the language disorder completely, and the seizure was controlled only by the addition of phenytoin immediately. Patients with NKH may initially present with isolated ASE. Unlike stroke-related aphasia, accurate diagnosis is difficult if based solely on neurologic examination and brain neuroimaging. Use of EEG and blood sugar determination should be helpful in this special case. Prompt treatment including correcting the hyperglycemia would substantially improve the outcomes of NKH but might be insufficient. Additional prompt use of antiepileptic drugs might be potentially more effective. J Neurol Res. 2016;6(4):85-88 doi: http://dx.doi.org/10.14740/jnr395w