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비케톤고혈당유발발작에서 자기공명영상과 자기공명분광

Magnetic Resonance Imaging and Magnetic Resonance Spectroscopy Findings in Non-Ketotic Hyperglycemia-Induced Seizures

Article information

J Korean Neurol Assoc. 2021;39(2):95-96
Publication date (electronic) : May 1, 2021
doi : http://dx.doi.org/10.17340/jkna.2021.2.8
Yuri Je, MD, Gha-Hyun Lee, MD
Department of Neurology, Pusan National University Hospital, Busan, Korea
제유리, 이가현
부산대학교병원 신경과
Address for correspondence: Gha-Hyun Lee, MD Department of Neurology, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea Tel: +82-51-240-7317 Fax: +82-51-245-2783 E-mail: ka-hyun-ii@hanmail.net
received : September 28, 2020 , rev-recd : January 6, 2021 , accepted : January 6, 2021 .

29세 남자가 3주 전부터 발생한 발작으로 왔다. 좌측 시야의 반짝거림으로 시작해 멍해지는 발작이 반복적으로 발생하였으며, 좌측 동측반맹이 보였다. 혈당 362 mg/dL, 당화혈색소 14.6%였고 뇌 magnetic resonance imaging (MRI)에서 비케톤고혈당유발발작에서 관찰되는 소견이 있었다(Fig. 1) [1]. 자기공명분광(magnetic resonance [MR] spectroscopy)에서는 젖산 증가와 N-아세틸아스파트산(N-acetyl aspartate, NAA) 감소를 보였다(Fig. 2). 항뇌전증제 사용 없이 혈당 조절 만으로 경련은 즉시 호전되었으며 좌측 반맹은 2주 후 호전되었다.

Figure 1.

Brain magnetic resonance images. (A) FLAIR images show the subcortical hypointensity in the right occipital area (arrows) with overlying cortical hyperintensity and gyral swelling. (B) Diffusion-weighted images show cortical high signal intensity (empty arrows) and (C) the ADC maps show low signal intensity in the corresponding area. (arrowheads). FLAIR; fluid attenuated inversion recovery, ADC; apparent diffusion coefficient.

Figure 2.

Magnetic resonance spectroscopy shows increased lactate (arrow), decreased N-acetyl aspartate (NAA) level (empty arrow), and decreased ratio of NAA/Cr (0.74) in the right occipital lobe.

비케톤성고혈당유발발작에서 특징적인 MRI 소견이 보이지만 병태생리 기전에 대해서는 정확히 알려져 있지 않다[1]. 환자의 MR spectroscopy를 고려하면 포도당 대사 장애로 인해 무산소대사의 표지자인 젖산이 증가하여 뇌실질 내 축적된 것이 반영되었을 가능성, 또는 반복적인 발작으로 인한 국소 뇌조직의 허혈성 변화에 의한 소견일 수 있다[2].

References

1. Lee EJ, Kim KK, Lee EK, Lee JE. Characteristic MRI findings in hyper glycaemia-induced seizures: diagnostic value of contrast-enhanced fluid-attenuated inversion recovery imaging. Clin Radiol 2016;71:1240–1247.
2. Zhu H, Barker PB. MR spectroscopy and spectroscopic imaging of the brain. Methods Mol Biol 2011;711:203–226.

Article information Continued

Copyright © 2021 Korean Neurological Association

Figure 1.

Figure 1.

Brain magnetic resonance images. (A) FLAIR images show the subcortical hypointensity in the right occipital area (arrows) with overlying cortical hyperintensity and gyral swelling. (B) Diffusion-weighted images show cortical high signal intensity (empty arrows) and (C) the ADC maps show low signal intensity in the corresponding area. (arrowheads). FLAIR; fluid attenuated inversion recovery, ADC; apparent diffusion coefficient.

Figure 2.

Figure 2.

Magnetic resonance spectroscopy shows increased lactate (arrow), decreased N-acetyl aspartate (NAA) level (empty arrow), and decreased ratio of NAA/Cr (0.74) in the right occipital lobe.