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An unusual electroencephalogram of a patient with diabetic acidosis

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Abstract

ELECTROENCEPHALOGRAPHIC evidence of changes in patients with diabetes mellitus is usually nonspecific, the changes being related to the state of consciousness. Specific abnormalities are usually attributed to an underlying condition other than diabetes mellitus. This paper presents the case history of a patient with long-standing brittle diabetes whose electroencephalogram had unusual features.

Report of a Case

A 59-year-old woman was first examined at the Cleveland Clinic in 1950 because she was unable to control the diabetes mellitus, which was diagnosed in 1947. She had been hospitalized for diabetic ketoacidosis five times during the three years after diagnosis, three times in the most recent four months.

In the 17 years in which her progress has been followed here, she has been hospitalized at least 25 times because of acidosis, with frequent trips to the Emergency Room for treatment of hypoglycemic reactions. Neurologic symptoms, which were present during the first few years, consisted of disorientation, incoherent speech, intermittent blurring of vision, headaches, and nausea. These symptoms were confined to periods of acidosis or of hypoglycemia. Results of neurologic examinations in the intervening periods were always within normal limits.

During 1958 she began to notice numbness in the backs of the legs. Neurologic examination revealed a decrease in vibratory sensation distally in the left leg, decreased perception of joint movement in the left great toe, asymmetry of deep-tendon reflexes, with the right knee jerk being greater than the left one, and a right extensor plantar response. The presumed diagnosis was that of myelopathy . . .


 

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