Diabetic Ketoacidosis Associated with a Transient Anton's Symptom and Gerstmann's Syndrome

The subject, a 26-year-old male diabetic, came out of a diabetic coma. On the 6th day post coma, he complained of slight headache, followed by lethargy the next day. Brain CT revealed low density regions in the bilateral occipital lobes which were suspected to be the result of cerebral infarction. Neurologic examination on the 7th day revealed blindness agnosia (Anton's symptom). Adiadochokinesis and other cerebellar ataxic symptoms were observed on the 13th day. After several days, Gerstmann's syndrome, including left-right agnosia, agraphia, acalculia and finger agnosia also occurred. Agraphia was marked with respect to hiragana. All of the above neurological deficits had appeared temporally. Perimetry revealed a right homonymous hemianopsia and bilateral expasion of Mariotte's blind spot; figures drawn by complications disappeared completely by the 30th post-coma day. With no sequelae, the patient was discharged from the hospital on the 38th post-coma day. Judging from the findings of gradual recovery of eyesight and the size reduction in the low density regions in the bilateral occipital lobes, we attributed the patient's disorder to a transient regional cerebral edema. It remains unknown why the present subject alone, unlike many other diabetic ketoacidosis patients, followed this unique disease course, and why the disorder occurred during the clinically and hematologically stable stage.