Abstract
A 47-year-old woman was referred to the emergency room of our hospital because of left hemiparesis and speech disturbance that she had first noticed when she woke up at 2:30 that morning. She gave a history of suffering from severe anorexia over the previous 10 days, during which she had not consumed much other than liquids. On arrival at 4:30 AM, the patient was found to be fully conscious and oriented, and a neurological examination revealed left hemiparesis involving the face. Head CT and head MRA did not reveal any abnormal findings, while diffusion-weighted MRI of the head revealed high-intensity areas in the posterior limb of the internal capsule and splenium of the corpus callosum bilaterally. The blood glucose concentration was 35 mg/dl. The symptoms and signs resolved promptly following intravenous administration of glucose. A laboratory examination revealed evidence of severe hyperthyroidism, and a test for TRAb was positive; the patient was diagnosed as having Basedow’s disease. The plasma levels of IRI and other glucose-regulating hormones were within the normal range, except for an elevated cortisol level, and a test for anti-insulin antibodies was negative. Based on these results, we concluded that the patient presented with hypoglycemia as a result of severe starvation in the presence of hyperthyroidism. To the best of our knowledge, this is the first report of Basedow’s disease manifesting as hypoglycemic hemiparesis. This case suggests the importance of ruling out hypoglycemic hemiparesis before considering rt-PA therapy in patients with Basedow’s disease.
