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Hyperglycemia presenting as left middle cerebral artery stroke: a case report
Nirav H Shah1, Victor Velez1, Teresita Casanova1
1University of Miami, Miller School of Medicine.
Journal of Vascular and Interventional Neurology
|November 26, 2014
Summary
Severe hyperglycemia can mimic stroke symptoms like neurological deficits. Prompt medical treatment to normalize blood glucose levels can reverse these effects, highlighting its importance in stroke differentials.
Area of Science:
- Neurology
- Endocrinology
Background:
- Hyperglycemia can present with focal neurological deficits, mimicking acute stroke.
- This phenomenon, a stroke mimic, is crucial to consider despite advanced neuroimaging techniques.
Purpose of the Study:
- To present a case where severe hyperglycemia mimicked a left Middle Cerebral Artery (MCA) syndrome.
- To discuss the diagnostic and therapeutic implications of hyperglycemia as a stroke mimic.
Main Methods:
- A case report of a 67-year-old woman with severe hyperglycemia (825 mg/dL) presenting with stroke-like symptoms.
- Neuroimaging (MRI/MRA) was negative for acute stroke, but showed perfusion abnormalities.
- Treatment involved medical resuscitation, including IV fluids and an insulin drip, to achieve normoglycemia.
Main Results:
- The patient's neurological deficits, including lethargy, global aphasia, and hemiparesis, resolved completely after achieving normal blood glucose levels.
- Electroencephalogram (EEG) showed transient left hemispheric slowing that normalized with treatment.
Conclusions:
- Severe hyperglycemia can present as a stroke mimic, specifically mimicking a left MCA syndrome.
- Resolution of deficits with medical management suggests a reversible condition, possibly due to metabolic demand-blood flow coupling rather than ischemic tissue injury.
