Dysglycemia-related neurological syndromes: Clinical and radiological mimics with complete reversibility

Dysglycemia, encompassing both hypoglycemia and hyperglycemia, can manifest with diverse neurological symptoms that mimic diverse conditions, including stroke, refractory status epilepticus, and autoimmune encephalitis. These atypical presentations often lead to diagnostic delays, underscoring the need for heightened awareness. We present a retrospective case series of five patients with dysglycemia-related neurological syndromes. Clinical details, laboratory findings, neuroimaging, and electroencephalography (EEG), and treatment outcomes were reviewed. The cases included: (1) Hypoglycemia mimicking acute ischemic stroke with reversible diffusion-weighted imaging (DWI) changes; (2) Nonketotic hyperglycemia presenting as pontine myelinolysis-like syndrome; (3) Hyperglycemia-induced refractory focal seizures with subcortical T2 hypo intensity in magnetic resonance imaging (MRI); (4) Chronic dysglycemia simulating autoimmune encephalitis with psychosis, cognitive impairment, and seizures; and (5) Hyperglycemia-associated occipital seizures with hemianopia and hyper perfusion on imaging. All patients achieved complete and sustained resolution with glycemic correction and supportive therapy. Notably, two cases revealed underlying chronic pancreatitis. Dysglycemia should be considered in the differential diagnosis of atypical neurological presentations, particularly when accompanied by reversible imaging abnormalities. Prompt recognition and management can prevent unnecessary interventions and improve outcomes.