Hypoglycemic Hemiparesis Presenting as a Stroke Mimic: A Case Report

Area of Science:

• Neurology
• Endocrinology
• Emergency Medicine

Background:

• Diabetes Mellitus (DM) management requires careful monitoring of blood glucose levels.
• Stroke-like symptoms necessitate rapid differential diagnosis, including metabolic causes.
• Hypoglycemia can manifest with focal neurological deficits, mimicking cerebrovascular events.

Observation:

• A 47-year-old male with DM presented with acute right-sided hemiparesis and slurred speech.
• Initial blood glucose was critically low (37 mg/dL), with rapid symptom resolution after intravenous dextrose administration.
• Cranial imaging (CT head, CT angiogram, MRI brain) revealed no evidence of stroke.

Findings:

• The patient's presentation was diagnosed as hypoglycemic hemiplegia, a stroke-like condition caused by severe hypoglycemia.
• The etiology was attributed to missed meals and an excessive diabetes medication regimen.
• Recurrent hypoglycemia (blood sugar 60 mg/dL) required a second dextrose dose.

Implications:

• This case highlights the importance of including blood glucose assessment in stroke protocols.
• Early detection and management of hypoglycemia can prevent misdiagnosis and ensure timely treatment.
• Understanding hypoglycemia's potential to mimic stroke is vital for emergency department and neurology consultations.