Non-convulsive status epileptics associated with diabetic ketosis: Case report and literature review

New-onset seizures in the elderly are a challenging presentation in the emergency department. Most of the cases have reported seizures on a background of non-ketotic hyperglycemia. We hereby present an elderly patient with non-convulsive status epilepticus (NCSE) following ketotic hyperglycemia. Patient presented with visual disturbances in the form of episodic polyopsia, metamorphopsia, and visual hallucinations for 2 weeks. MRI brain showed T2 and FLAIR hyperintensity in left occipito-temporal cortex with subcortical hypointensity. EEG revealed spikes in bilateral occipito-temporal regions suggestive of NCSE. Patient showed gradual improvement with correction of hyperglycemia. In conclusions, non-convulsive status epilepticus is an important consideration in an elderly diabetic with recent onset of confusional state.