Case Report and Brief Review: Hypoglycemic Hemiplegia as a Stroke Mimic

Here we present the case of a 47-year-old male with a history of diabetes mellitus (DM), who was brought to the emergency department with right sided hemiparesis and slurred speech. His blood sugar was 37 mg/dL. An intravenous line was established quickly, and the patient was administered intravenous dextrose. Within five minutes, his symptoms had significantly improved and by 10 minutes had resolved completely. A CT head and CT angiogram of the head and neck were within normal limits. Basic laboratory tests were within normal limits. The initial neurology service consult noted that his diagnosis was hypoglycemic hemiplegia. The patient was admitted to the hospital for evaluation of blood sugar and for an MRI brain. The patient required one more dose of dextrose two hours after arrival for a blood sugar of 60 mg/dL. The MRI brain was normal. This case illustrates that hypoglycemia can present with stroke-like symptoms. Non-stroke diagnoses that present with stroke-like symptoms are referred to the in the medical literature as “stroke mimics” and such presentations can imitate acute ischemia in up to 30% of suspected stroke cases The actual mechanism of hemiparesis has not been completely clarified. There are several theories. One is vasospasm. Perhaps the most common current hypothesis that some regions of the brain with greater metabolic activity have greater vulnerability to hypoglycemia. In our case, the ideology of the hypoglycemia itself was probably associated with missed meals and relatively excessive medication regimen for diabetes. It is for such cases as the one presented that stroke protocols emphasize early assessment of the blood glucose level.