Hypoglycemia: Causes, neurological manifestations, and outcome

Abstract

During a 12-month prospective study there were 125 visits to the Harlem Hospital Emergency Room for symptomatic hypoglycemia. Sixty-five patients had obtundation, stupor, or coma; 38 had confusion or bizarre behavior; 10 were dizzy or tremulous; 9 had had seizures; and 3 had suffered sudden hemiparesis. Diabetes mellitus, alcoholism, and sepsis, alone or in combination, accounted for 90% of predisposing conditions; others included fasting, terminal cancer, gastroenteritis, insulin abuse, and myxedema. Average blood glucose levels were lower among comatose than among obtunded patients, but overlap was considerable, and overall there was little correlation among cause, blood glucose levels, and symptoms. Although mortality was 11%, only one death was attributable to hypoglycemia per se, and only four survivors had focal neurological residua.

Clinical features of stroke mimics in the emergency department

“…peripheral nerve disorder and autonomic nervous disorder). Malouf et al 19. reported that approximately 9% of hypoglycemic patients present with neurological symptoms other than consciousness alteration.…”

Hypoglycemic hemiplegia: two cases and a clinical review.

“…12 In a group of 125 consecutive patients admitted to Harlem Hospital over a 12-month period with symptomatic hypoglycemia, 3 (2%) experienced transient hemiparesis. 2 HH is probably under-recognized. It is our impression that most physicians who are aware of this entity and who care for diabetic patients have seen patients with suspected or definite HH.…”

Neurologic Manifestations of Hypoglycemia

“…52,53 It appears to be rare, with case series reporting an incidence of 2% among those admitted with hypoglycemia. 29 Objective weakness was found in 7 patients with hypoglycemia from insulinoma; 3 had hemiparesis, 2 had paraparesis and 2 had monoparesis. On average the weakness resolved over a period of 1 hr to 3 days once normoglycaemia was maintained.…”

“…Four patients had residual neurologic symptoms after resolution of hypoglycemia. 29 The neurological manifestations of thirty patients with hypoglycemia from insulinoma were described by Daggett and Nabarro. 30 They found that the most common presentation was confusion (20 cases), followed by coma (16 cases), seizures (8 cases) and weakness (8 cases).…”

“…28 In 1985, Malouf and Brust evaluated 125 patients with hypoglycemia presenting to a local hospital over a one year period. 29 Among their study cohort, sixty-five patients were obtunded, stuporous, or comatose. Another 38 had confusion or "bizarre" behavior, 10 were dizzy or tremulous, 9 had seizures, and 3 had hemiparesis.…”