A case of hemiplegia with hypoglycemia possibly associated with hemodynamic change

• Published in: Diabetology international 2015-12, Vol.6 (4), p.336-340
• Main Authors: Matsuda, Tomokazu, Iwasaki, Masaya, Yoshioka, Nami, Hirota, Yushi, Hamaguchi, Hirotoshi, Kido, Yoshiaki, Sakaguchi, Kazuhiko, Ogawa, Wataru
• Format: Article
• Language: English
• Subjects: Case Report; Diabetes; Endocrinology; Medicine; Medicine & Public Health; Metabolic Diseases
• ISSN: 2190-1678; 2190-1686
• DOI: 10.1007/s13340-014-0195-6

Fear of iatrogenic hypoglycemia associated with insulin therapy or oral hypoglycemic agents may prevent patients from achieving appropriate control of blood glucose levels. Such episodes also often impair quality of life and can be fatal. Hypoglycemia-induced hemiplegia is a neurological sign that is thought to result from selective neuronal vulnerability to low blood glucose and is readily reversed by glucose administration. A differential diagnosis of such hypoglycemia-induced hemiplegia relative to ischemic cerebrovascular conditions is important given the substantial differences in prognosis. We now report a case of hemiplegia induced by hemodynamic change in association with hypoglycemia, with this condition being differentiated clinically from typical hypoglycemia-induced hemiplegia. An 85-year-old woman presented with left-sided hemiplegia that was rapidly resolved by intravenous glucose administration. Magnetic resonance imaging revealed no acute changes in the brain parenchyma, whereas diffusion-weighted images typically show high-intensity areas in cases of hypoglycemia-induced hemiplegia. Magnetic resonance angiography revealed advanced stenosis of the right internal carotid artery. Furthermore, whereas single-photon emission computed tomography showed no abnormality in blood flow at rest, it revealed marked impairment of blood flow in the right hemicerebrum after loading with acetazolamide, consistent with the advanced arteriosclerosis. The impaired cerebral flow reserve was thus likely exacerbated by hypoglycemia and evoked transient hemiplegia. As far as we are aware, this is the first report of a hypoglycemia-induced transient ischemic attack in the presence of underlying arteriosclerosis. The cerebrovascular state of patients with hemiplegia and hypoglycemia should thus be appropriately assessed to prevent future cerebral infarction.