Hypoglycemic Hemiparesis Presenting as a Stroke Mimic: A Case Report

TL;DR

A diabetic man showed stroke-like symptoms due to low blood sugar, which resolved after glucose treatment, highlighting the importance of checking blood sugar in stroke-like cases.

Contribution

This case emphasizes hypoglycemia as a stroke mimic and reinforces the need for early glucose assessment in stroke protocols.

Findings

The patient's stroke-like symptoms resolved after intravenous dextrose administration.

Hypoglycemia was caused by missed meals and excessive diabetes medication.

Neuroimaging and lab tests were normal, confirming hypoglycemic hemiplegia.

Abstract

Here, we present the case of a 47-year-old male with a history of diabetes mellitus (DM), who was brought to the emergency department (ED) with right-sided hemiparesis and slurred speech. His blood sugar was 37 mg/dL. An intravenous line was established, and the patient was administered intravenous dextrose. Within five minutes, his symptoms had significantly improved and, by 15 minutes, had resolved completely. A CT head and CT angiogram of the head and neck were within normal limits. Basic laboratory tests were within normal limits. The initial neurology service consult concluded that his diagnosis was hypoglycemic hemiplegia. The patient was admitted to the hospital for evaluation of blood sugar and for an MRI brain. The patient required one more dose of dextrose two hours after arrival for a blood sugar of 60 mg/dL. The MRI brain was normal. This case illustrates that hypoglycemia can present with stroke-like symptoms. In our case, the etiology of the hypoglycemia itself was associated with missed meals and a relatively excessive medication regimen for diabetes. It is for such cases as the one presented that stroke protocols emphasize early assessment of the blood glucose level.