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Hypoglycemic Hemiparesis Masquerading As Ischemic Stroke: When Guideline Fails

[ Vol. 15 , Issue. 4 ]

Author(s):

Dhruvkumar M. Patel, Mukundkumar V. Patel *, Jayanti K. Gurumukhani, Maitri M. Patel, Himal J. Mahadevia and Ritesh A. Gajjar   Pages 420 - 422 ( 3 )

Abstract:


Background: Hypoglycemia may rarely present as hemiparesis and sometimes, it is difficult to differentiate from ischemic stroke. When random blood sugar (RBS) value is between 50 and 70 mg% in patients presenting with focal neurological deficit, no guideline exists to consider the possibility of hypoglycemia before initiating thrombolytic therapy.

Clinical Case: A 58-year-old male, with preexisting illness of diabetes and hypertension diabetes and hypertension, was brought to the emergency room with acute onset of right hemiparesis and dysarthria of 90 minutes duration. His NIHSS Score was 9, blood pressure was 150/90 mm of Hg and RBS was 79 mg% on admission. His CT scan brain was normal and was considered for thrombolysis. The resident doctor was not aware of previous sugar repeated RBS before thrombolysis, which was surprisingly 60 mg% 60 minutes after the first RBS. Even though he was a candidate for thrombolysis, intravenous 25% dextrose was administered considering the possibility of hypoglycemia. He made a complete recovery within 20 minutes and thrombolytic therapy was withheld.

In diabetic patients with focal neurological deficit and RBS less than 80 mg% on admission, RBS should be rechecked and in appropriate cases, should be challenged with IV dextrose considering the possibility of hypoglycemia before commencing thrombolytic therapy.

Keywords:

Hypoglycemia, hemiparesis, ischemic stroke, thrombolysis, stroke thrombolysis guidelines.

Affiliation:

M.O, Dhruv Healthcare Multi-speciality Hospital, Ahmedabad, Dhruv Healthcare Multi-speciality Hospital, Ahmedabad, Consultant neurologist, Jay Neurocare and Physiotherapy Clinic, Bhavnagar, UG student, GCS Medical College and Hospital Ahmedabad, Intern doctor, B. J. Medical college, Ahmedabad, Intern, B. J. Medical College, Ahmedabad



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