Teaching NeuroImages: MRI abnormalities in frontal lobe seizures due to nonketotic hyperglycemia

A 56-year-old woman presented with electroclinical focal seizures in the setting of hyperglycemia (808 mg/dL) and elevated HbA1c of 14.7%. She had varying seizure semiology, consisting of early forced head turn to the left, speech arrest, left facial twitching, and impaired awareness. Her seizures arose from the right frontotemporal area on EEG (figure 1). MRI showed hypointensities in the right prefrontal lobe that resolved after 6 months (figure 2).