[Transient hypoglycemic hemiplegia due to insulin autoimmune syndrome--a case report]

Hypoglycemia causes a variety of neurologic symptoms, and yet it is rarely responsible for such a sudden, focal neurologic deficit as hemiplegia. Herein we described a rare case of what was believed to be transient hypoglycemic hemiplegia. An 80-year-old woman was admitted to the hospital on June 10, 1988, following frequent episodes of abnormal behavior and transient weakness of the right extremities. These symptoms, similar to those of cerebrovascular diseases, characteristically occurred early in the morning and disappeared after breakfast. On admission no definite abnormalities were disclosed on neurologic examination. Neuroradiological evaluations by CT, cerebral angiography and single photon emission CT failed to demonstrate abnormalities. The patient remained stable until the following morning, when she suddenly became restless and confused and developed total aphasia and the right hemiplegia. The blood sugar was estimated to be 34 mg/dl and electroencephalogram (EEG) showed continuous slow wave activities involving the bilateral fronto-parietal region. Intravenous injection of glucose solution instantaneously resulted in disappearance of both neurologic symptoms and EEG abnormality. Serum insulin level was found extremely increased ranging from 7000 to 8000 microU, eventually leading to a diagnosis of insulin autoimmune syndrome. Hemiplegia due to hypoglycemic attack was reviewed in the literature, and the pathogenesis and EEG findings were also discussed.