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Homonymous quadrantanopia associated with hyperosmolar hyperglycemic syndrome.

Chika Mizuguchi1, Yuka Sato2, Hiroki Imai1

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|March 28, 2020
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Summary

This study reports a rare case of vision loss, specifically right inferior quadrantanopia, in a patient with hyperosmolar hyperglycemic syndrome. This visual disturbance may represent a unique hemianopia variant associated with this hyperglycemic state.

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Area of Science:

  • Neuro-ophthalmology
  • Endocrinology
  • Diabetic Complications

Background:

  • Hyperosmolar hyperglycemic syndrome (HHS) is a severe diabetic emergency characterized by extreme hyperglycemia and dehydration.
  • Neurological complications in HHS are typically associated with osmotic shifts and electrolyte imbalances, but visual disturbances are not commonly reported.
  • Ocular manifestations of diabetes are well-documented, but specific visual field defects linked to HHS require further investigation.

Observation:

  • A 64-year-old male presented with sudden onset of right inferior quadrantanopia, a specific type of visual field defect.
  • The patient was diagnosed with hyperosmolar hyperglycemic syndrome, marked by significantly elevated blood glucose levels.
  • This presentation represents the first documented instance of quadrantanopia in the context of HHS.

Findings:

  • The observed homonymous right inferior quadrantanopia is a novel finding in patients with hyperosmolar hyperglycemic syndrome.
  • This visual phenomenon is hypothesized to be a variant of hemianopia, a broader category of visual field loss.
  • The exact mechanism linking HHS to this specific visual field defect requires further elucidation.

Implications:

  • This case expands the spectrum of neurological manifestations associated with hyperosmolar hyperglycemic syndrome.
  • It highlights the importance of ophthalmological and neurological assessments in patients with HHS presenting with visual symptoms.
  • Further research is warranted to understand the pathophysiology and clinical significance of visual field defects in HHS.