title: A case of hypoglycemic hemiparesis and literature review.
abstract: An 89-year-old man with diabetes treated with metformin 500 mg/day and glimepiride 4 mg/day was hospitalized because of hypoglycemic right hemiparesis and dysarthria (casual glucose value 1.8 mmol/L), which resolved quickly following administration of 40 mL of 40% dextrose. Hemiparesis is a rare symptom (4.2%) of hypoglycemia. There are about 200 case reports of hypoglycemic hemiparesis. The average glucose level at which hemiparesis developed was 1.8 mmol/L. Right-sided hemiparesis predominated (R 66%; L 34%). On imaging studies, abnormal findings were frequently observed in the internal capsule or splenium of the corpus callosum. The mechanism of hemiparesis is not fully understood. The existence of cases in which hypoglycemia cannot be distinguished from stroke on imaging studies suggests the importance of measurement of the blood glucose level when the symptoms of stroke are first recognized.
authors.affiliation: Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine Keio University, School of Medicine, Shinjuku, Japan. tetta213@yahoo.co.jp
authors.forename: Tetsuhiro
authors.initials: T
authors.lastname: Yoshino
authors.forename: Shu
authors.initials: S
authors.lastname: Meguro
authors.forename: Yukie
authors.initials: Y
authors.lastname: Soeda
authors.forename: Arata
authors.initials: A
authors.lastname: Itoh
authors.forename: Toshihide
authors.initials: T
authors.lastname: Kawai
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Itoh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D003920:Diabetes Mellitus / Q000188:drug therapy; D006801:Humans; D007003:Hypoglycemia / Q000150:complications*; D008297:Male; D008687:Metformin / Q000008:administration & dosage / Q000627:therapeutic use; D010291:Paresis / Q000175:diagnosis* / Q000209:etiology; D013453:Sulfonylurea Compounds / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D001786:Blood Glucose; D013453:Sulfonylurea Compounds; C057619:glimepiride; D008687:Metformin