Hypoglycemia masquerading as cerebrovascular disease (hypoglycemic hemiplegia)

Abstract

Hypoglycemia produced hemiplegia with right-sided predilection in 16 patients initially suspected of having suffered a stroke. Fifteen patients had no demonstrable brain disease, and the hemiplegia cleared rapidly once the hypoglycemia was corrected. Invasive investigations such as carotid arteriography are not required in most patients. The features of hypoglycemia hemiplegia suggest that a selective neuronal vulnerability and not underlying focal brain disease is responsible in most cases.

Hypoglycemic hemiplegia: two cases and a clinical review.

“…Hypoglycemia purposely induced by insulin infusion, undertaken in an attempt to reproduce HH, has unpredictably resulted in hemiplegia. 3 Based on 29 well-documented cases from the literature, the clinical spectrum of HH is outlined in Table 1. 3 -" 13 -15 HH usually occurs in diabetic patients receiving insulin (72%) or oral hypoglycemic agents (14%), but HH also occurs in nondiabetic patients with other causes of hypoglycemia (14%).…”

“…12 Yet in certain patients, hypoglycemia presents with isolated, focal neurologic signs. 3 " 10 In these patients, the diagnosis is not readily apparent, leading to unnecessary evaluation for cerebrovascular disease. Two such cases are reported.…”

Neurologic Manifestations of Hypoglycemia

“…reviewed 16 patients presenting with weakness and blood glucose of less than 45 mg/dl. 54 Most patients were initially misdiagnosed as stroke, all but one were conscious during the attack, four had associated aphasia, most (12/16) had right sided weakness and all had resolution without recurrence within 15 minutes of glucose infusion. One of the www.intechopen.com patients had a total of four episodes of transient hemiplegia before hypoglycemia was diagnosed.…”

“…Autopsy of this patient showed diffuse cortical injury, but no focal lesions. 54 Another review involving 29 patients found 72% were caused by insulin treatment, and mean serum glucose was 35 mg/dL. Most (78%) had recurrent attacks, and on average 3.5 attacks occurred before a diagnosis of hypoglycemic hemiparesis was made.…”

“…Autopsy studies have not demonstrated lesions in vascular territories, but rather diffuse damage. 11,54 Hypoglycemia has been shown to produce vasodilatation in animals, unlike vasoconstriction seen in stroke. 62 Although case reports have shown patients with hypoglycemic hemiplegia and associated carotid artery stenosis, most others have not validated this observation.…”