title: Hyperglycemia presenting as left middle cerebral artery stroke: a case report.
abstract: OBJECTIVE
  Hyperglycemia is an important diagnostic differential and has been reported to cause focal neurological deficits masquerading as stroke. Discussion of hyperglycemia as a stroke mimic has been sparse in the era of diffusion weighted imaging, but remains an important mimic.
  
  
  METHODS
  A 67 year-old right-handed woman with presented with lethargy, global aphasia, left eye deviation and right hemiparesis. She received IV t-PA for left MCA syndrome and transferred for possible intervention. Initial labs showed a glucose 825mg/dL. MRI/MRA brain was negative for acute stroke with patent vessels, but abnormalities on MRperfusion. The patient was admitted and treated with medical resuscitation including IV fluids and an insulin drip. After normoglycemia was achieved the patient's neurological deficits resolved. EEG on day one of hospitalization showed left hemispheric slowing that subsequently normalized on continuous recording.
  
  
  CONCLUSIONS
  We report a case of hyperglycemia clinically mimicking a left MCA syndrome reversed with medical management possibly explained by metabolic demand-blood flow coupling of inactive tissue rather than hypoperfused tissue at risk of infarction.
authors.affiliation: University of Miami, Miller School of Medicine.
authors.forename: Nirav H
authors.initials: NH
authors.lastname: Shah
authors.affiliation: University of Miami, Miller School of Medicine.
authors.forename: Victor
authors.initials: V
authors.lastname: Velez
authors.affiliation: University of Miami, Miller School of Medicine.
authors.forename: Teresita
authors.initials: T
authors.lastname: Casanova
authors.affiliation: University of Miami, Miller School of Medicine.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Koch
keywords: Hyperglycemia; Stroke; Stroke mimic