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Hypoglycemia is considered a clinical syndrome with systemic, neurological, and psychiatric manifestations; it occurs often in diabetics treated with insulin or oral hypoglycemic agents.' The clinical diagnosis of hypoglycemia is made when signs and symptoms of adrenergic discharge appear in combination with altered mental status. However, in some patients hypoglycemia can present with isolated, focal neurological symptoms and signs.2,3 These features may masquerade a cerebrovascular disorder. We describe a patient who developed acute tetraplegia due to hypoglycemia within a few hours after the onset of the first symptoms. Symptoms ceased immediately after administration of intravenous glucose.A 71-year-old diabetic man had been taking oral hypoglycemic agents (5 mg/day Glibenclamide) for 3 years and had associated chronic renal disease, atrial fibrillation (for which he was taking 2 mg/day Acenocoumarol), and a prostate adenocarcinoma (diagnosed 2 years previously). He was seen as an emergency case because 48 hours before admission he experienced an episode of asthenia and profuse sweating. On the day of admission, he developed acute progressive global weakness in all four extremities. On initial examination, he was alert and well orientated but had bulbar dysarthria. External ocular movements were normal. A left facial palsy of central origin was detected. Motor examination revealed a flaccid tetraplegia with an extensor plantar response on the left and an indifferent response on the right. All sensory modalities appeared normal.These symptoms were interpreted initially as progressive vertebrobasilar ischemia, but blood glucose was 29 mg/dl.Immediate intravenous administration of 10 ml 33% glucose produced recovery within 3 minutes, and the neurological deficit disappeared completely.Because of the clear correlation between the improvement of the neurological symptoms and signs and glucose injection, angiography was not performed. However, computed tomographic scan and magnetic resonance imaging were performed to exclude any associated vascular or neoformative lesion; results of both were normal.Hypoglycemia is a common cause of neurological and psychiatric disturbances and can occasionally generate diagnostic difficulties when focal neurological symptoms appear without associated adrenergic symptoms that mimic cerebrovascular ischemic events. Hemiplegia caused by hypoglycemia has been recognized for more than 50 years.4 Nevertheless, tetraplegia has been scarcely reported; only Rother et a15 reported a patient who had progressive brain stem symptoms due to a diet-induced hypoglycemia. We describe a patient with acute tetraplegia with preserved consciousness and oculomotor function. Initially a diagnosis of probable progressive vertebrobasilar ischemia was made, but symptoms ceased immediately after intravenous glucose. The mechanism of focal neurological signs in hypoglycemia is unknown; a selective neuronal vulnerability is the most likely explanation other than the aggravation of underlying neurological dis...

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