Transient Homonymous Hemianopia and Positive Visual Phenomena in Patients With Nonketotic Hyperglycemia | Ophthalmology | JAMA Ophthalmology | JAMA Network
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Clinicopathologic Reports, Case Reports, and Small Case Series
June 2007

Transient Homonymous Hemianopia and Positive Visual Phenomena in Patients With Nonketotic Hyperglycemia

Arch Ophthalmol. 2007;125(6):845-847. doi:10.1001/archopht.125.6.845

Homonymous hemianopic visual field defects usually result from structural processes affecting retrochiasmal visual pathways. Cranial magnetic resonance imaging typically identifies the responsible lesions. Etiologies of homonymous hemianopias and normal neuroimaging include the Heidenhain variant of Creutzfeldt-Jakob disease, the visual variant of Alzheimer disease, occipital or global ischemia/hypoxia, MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes), anemia, migraine, occipital seizures, functional illness, and nonketotic hyperglycemia (NKH).1 Herein, we report a case of transient homonymous hemianopia and positive visual symptoms caused by NKH and review the literature on this rare phenomenon.

A 68-year-old man had well-controlled type 2 diabetes mellitus (blood glucose levels consistently 90-130 mg/dL [5.00-7.22 mmol/L]). His physician changed his medication to insulin glargine in early December 2004, which resulted in poorly controlled blood glucose levels that were consistently more than 600 mg/dL (33.31 mmol/L) until early January. He developed intermittent photopsias, visual hallucinations, and “distorted” vision OU in the middle of December 2004. He denied having any other visual or neurologic symptoms.

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