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The article by Taban et al1 is both important and interesting; it is important because the condition is not as rare as the authors lead us to believe,2 - 5 and interesting because their patient's magnetic resonance image (MRI) was reported as normal, which has not been our experience.2
We would be most interested in seeing the images, which were not published. In our experience most patients with nonketotic hyperglycemic hemianopia have abnormal MRI findings,2 though they are sometimes quite subtle and often missed. One of us (P.L.) reported 4 patients with reversible homonymous hemianopias and reversible MRI abnormalities attributed to nonketotic hyperglycemia (NKH).2 In 3 patients the findings were subtle and overlooked initially by radiologists. The most obvious findings2 were decreased T2 signal of the white matter, subtle gyral swelling, enhancement of the overlying meninges, and restricted diffusion, predominantly in the posterior hemisphere opposite the hemianopia.
Even if the patient described by Taban and colleagues had a normal MRI, it is important to be aware of the potential, now well-described, changes2 - 4 ; they may be a safety net when the disorder is not diagnosed initially. Nonketotic hyperglycemia is a treatable condition, but with significant morbidity and mortality. In an emergency department NKH may be diagnosed fortuitously by routine blood tests. However, in an outpatient setting where such tests are not routine, NKH should be considered in the differential diagnosis of an unexplained recent hemianopia or other unusual visual symptoms. Such patients may arrive with an MRI in hand; 2 of the 4 patients in Lavin's article came to our outpatients clinic.
Correspondence: Dr Lavin, Departments of Neurology and Ophthalmology, Vanderbilt University Medical Center, A-0118 Medical Center North, Nashville, TN 37232-2551 (patrick.lavin@vanderbilt.edu).
Financial Disclosure: None reported.
Funding/Support: This study was supported by a Challenge Grant from Research to Prevent Blindness Inc.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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