Abstract
A 79-year-old female had medication for diabetes mellitus. She presented with dysarthria and right hemiplegia suddenly after supper. Diffusion weighted imaging (DWI) revealed a hyper-intensity lesion in the left internal capsule, and acute ischemic stroke was suspected. However, these symptoms disappeared rapidly after glucose infusion because plasma glucose level was 35 mg/dl. DWI obtained 24 hours later showed complete resolution of the hyper-intensity lesion in the left internal capsule.
Recently, tissue type plasminogen activator (tPA) was approved for acute ischemic stroke within 3 hours from onset, and was thought to be more effective if tPA is administrated as early as possible. Generally, in the case of glucose level under 50 mg/dl, administration of tPA is a contraindication. Hypoglycemic symptoms can be classified as autonomic and neuroglycopenic. Hypoglycemic hemiparesis is well-defined, ranging from reversible focal deficits to irreversible coma and death, but these cases are very rare. For the emerging patients presenting with focal neurological signs, hypoglycemic hemiparesis may be misdiagnosed as transient ischemic attack or acute cerebral infarction.
For the administration of tPA, we must never overlook hypoglycemia. For patients presenting with focal neurological signs, we should always take hypoglycemic hemiparesis into consideration, and early treatment must be started because the patients may have permanent disability if not treated promptly with glucose intake.
