Rare brain computed tomography image findings of hyperosmolar hyperglycemic state due to acute ischemic stroke-induced stressed hyperglycemia: A case report

Hyperosmolar hyperglycemic state (HHS) is a severe complication of diabetes mellitus (DM), often triggered by acute illnesses such as stroke. A 68-year-old female with hypertension and type 2 DM presented with recurrent seizures and right-sided weakness. Severe hyperglycemia (839 mg/dL), renal impairment, and electrolyte imbalances confirmed HHS. Brain computed tomography imaging showed hyperdense lesions in the lentiform nucleus and caudate nuclei, suggesting metabolic and ischemic contributions. Intensive fluid resuscitation and insulin therapy led to clinical improvement. Stroke-induced stress hyperglycemia exacerbated metabolic dysfunction, progressing to HHS. This case highlights the importance of early recognition and aggressive management of hyperglycemia in acute stroke to prevent life-threatening complications.