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Hypoglycemic hemiplegia.

J P Pazevic1, R L Hambrick, S A Roskam

  • 1Department of Emergency Medicine, Chicago College of Osteopathic Medicine, IL.

The Journal of the American Osteopathic Association
|June 1, 1990
PubMed
Summary
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Hypoglycemia, or low blood sugar, can cause stroke-like symptoms such as hemiplegia. This case report details an elderly patient experiencing hypoglycemic hemiplegia due to insulin, highlighting the importance of considering blood glucose levels in neurological presentations.

Area of Science:

  • Neurology
  • Endocrinology
  • Internal Medicine

Background:

  • Hypoglycemia, commonly associated with diabetes management, typically presents with autonomic symptoms like tachycardia and diaphoresis.
  • Severe hypoglycemia can lead to altered mental status, seizures, coma, and potentially death.
  • Less commonly, hypoglycemia may manifest with focal neurological deficits mimicking cerebrovascular accidents (CVAs).

Observation:

  • This report details an elderly patient who developed hemiplegia, a focal neurological sign, following insulin administration.
  • The patient's presentation mimicked a stroke, underscoring the diagnostic challenge posed by hypoglycemic hemiplegia.
  • Preservation of mental status in the presence of hemiplegia can be a key, though not exclusive, indicator for considering hypoglycemia.

Findings:

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  • Hypoglycemic hemiplegia is a rare but significant neurological complication of insulin therapy.
  • The underlying mechanisms involve impaired glucose metabolism in specific brain regions, leading to focal neurological deficits.
  • Prompt recognition and management of hypoglycemia are crucial to reverse these neurological symptoms and prevent permanent damage.

Implications:

  • Clinicians must consider hypoglycemia in the differential diagnosis of acute focal neurological deficits, especially in patients with diabetes or those receiving insulin.
  • Accurate blood glucose monitoring is essential for patients presenting with stroke-like symptoms.
  • Understanding hypoglycemic hemiplegia can improve diagnostic accuracy and therapeutic interventions, potentially reducing misdiagnosis as a CVA.