Spectrum of hyperosmolar hyperglycaemic state in neurology practice

Area of Science:

• Neurology
• Endocrinology
• Internal Medicine

Background:

• Hyperosmolar hyperglycaemic state (HHS) is a critical medical emergency.
• Limited studies detail the neurological manifestations of HHS.
• This study investigates the spectrum of neurological symptoms, triggers, and outcomes in HHS patients within general neurology practice.

Purpose of the Study:

• To document the range of neurological presentations in HHS.
• To identify factors that precipitate HHS.
• To assess the outcomes of HHS patients managed in a neurology setting.

Main Methods:

• Retrospective and prospective data collection from a hospital information system.
• Analysis of demographic data, clinical features, diabetes history, and precipitating events (infection, stress, stroke).
• Classification of HHS patients into seizure, movement disorder, and encephalopathy groups, with EEG, MRI, and outcome assessment.

Main Results:

• Seventeen HHS patients (40-75 years, 7 female) were studied.
• Neurological presentations included encephalopathy (9), seizures (5), and hemichorea-hemiballismus (3).
• Stroke was the most common precipitant for encephalopathy; infections triggered movement disorders. Complete recovery occurred in 9 patients.

Conclusions:

• Encephalopathy, seizures, and hemichorea-hemiballismus are key neurological manifestations of HHS.
• These neurological symptoms generally respond to correction of the hyperosmolar state.
• Outcomes vary, with some patients experiencing persistent neurological deficits, particularly those with stroke or severe complications.