Hypoglycaemic haemiparesis

Abstract

SUMMARYHypoglycaemic haemiparesis (HH) is an uncommon but important presentation to the emergency department, and it often mimics stroke and is therefore frequently misdiagnosed by clinicians. The mechanism of haemiparesis is not fully understood. This case outlines a diabetic elderly woman, who had been having frequent hypoglycaemic episodes and presented to paramedics with hypoglycaemia associated with a right-sided haemiparesis. She was immediately transferred to the local stroke centre after presenting to the emergency department. CT and MRI did not fit in with her presenting neurology. Her weakness resolved, after normoglycaemia was achieved with dextrose infusion; however, she was reported to be more sleepy and drowsy than usual. After extensive and costly investigations during her prolonged inpatient stay, her unifying diagnosis was an HH which triggered of a hypoactive delirium. BACKGROUND

Risk factors for hypoactive delirium in patients with nontraumatic ARDS: a prospective observational study

“…Numerous studies have reported that diabetes mellitus is closely related to the development of delirium. Kirresh et al 16 reported a case of hypoactive delirium induced by hypoglycemic hemiparesis, and Kotfis et al 17 reported that diabetes and elevated HbA1c levels are risk factors for delirium after cardiac surgery. Some systematic reviews and meta-analyses also revealed that the incidence of delirium is significantly increased in diabetic patients 18 , 19 .…”

Case report - sulfonylurea poisoning mimicking vertebrobasilar acute ischemic stroke

“…According to literature, approximately 200 cases of hypoglycemia induced hemiparesis [10], of which 10 occurred with the use of sulfonylureas, have been published. [11][12][13][14][15][16][17][18][19][20]. One case of hemiparesis appeared with tolbutamide [11], four with glibenclamide [12][13][14], three with glyburide [16][17][18] and two with gliclazide treatment [19][20].…”

“…Only one case of tetraplegia after sulfonylureas was reported, however, in comparison to our case, neurological deficits disappeared after proper glucose level was restored. [11][12][13][14][15][16][17][18][19][20][21]. Only one case study described an incident of hypoglycemia imitating cerebellar AIS in a 55-year-old diabetic woman with sudden onset of unilateral cerebellar symptoms treated with glibenclamide [14].…”

“…Only one case study described an incident of hypoglycemia imitating cerebellar AIS in a 55-year-old diabetic woman with sudden onset of unilateral cerebellar symptoms treated with glibenclamide [14]. Most of the neuroglycopenia cases were caused by sulfonylureas in the standard dose and one of them was an attempted suicide with 30 tablets of 75 mg glybenclamide [15]. Out of 10 cases of hemiparesis after hypoglycemia, only one case described a child (a 6-year-old took her grandmother's medications) [16].…”