Hypoglycemia with focal neurological signs as stroke mimic: Clinical and neuroradiological characteristics.
Our aim was to investigate the clinical and radiological features of patients with hypoglycemia with focal neurological signs (HFNS). Among 80 consecutive hypoglycemic patients (blood glucose levels less than 50mg/dL), who had been admitted between October 2008 and May 2012, we selected 11 patients (6 men and 5 women; mean age, 73.2 ± 12 years) with focal neurological signs. The mean initial blood glucose level was 27.9 mg/dL (range, 13-39 mg/dL). The most frequent symptom was unilateral motor weakness (n = 9), which was usually accompanied with mild or moderate alteration of consciousness. All patients had improved initial neurological signs within 1h of glucose injection. The initial DWI demonstrated a hyperintense lesion in the contralateral internal capsule with decreased values on the ADC (apparent diffusion coefficient) map in 2 of the patients (18%). The DWI performed one day later shows only faint lesion. The initial DWI in patients with HFNS may display a hyperintense lesion, which was difficult to distinguish from acute cerebral infarction. Hypoglycemia should be considered in cases with DWI showing a disproportionally small lesion in contrast to neurological signs.
Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan. Electronic address: scio@f8.dion.ne.jp.
Tomohiko
T
Ohshita
Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan. Electronic address: eijiima5@yahoo.co.jp.
Eiji
E
Imamura
Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan. Electronic address: nomura@mwc.biglobe.ne.jp.
Eiichi
E
Nomura
Department of Neurosurgery, Suiseikai Kajikawa Hospital, Hiroshima, Japan. Electronic address: s-wakabayashi@mtf.biglobe.ne.jp.
Shinichi
S
Wakabayashi
Department of Neurosurgery, Suiseikai Kajikawa Hospital, Hiroshima, Japan. Electronic address: hkajikawa@suiseikai.jp.
Hiroshi
H
Kajikawa
Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan. Electronic address: mack@hiroshima-u.ac.jp.
Masayasu
M
Matsumoto
D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000150:complications*; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000209:etiology; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology*; D020521:Stroke / Q000503:physiopathology*
DWI; Focal neurological signs; Hypoglycemia; Internal capsule; MRI; Stroke mimic