1500 - Hypoglycemia-Induced Cerebral Injury Mimicking Stroke: A Diagnostic Challenge in a Multimorbid Elderly Patient

Case Diagnosis: Hypoglycemic induced Cerebral Injury

Case Description: 79-year-old male with a PMHx of multiple cancers, IDDM, hypertension and polymyalgia rheumatica presented with severe aphasia, apraxia and right-sided hemiparesis. EMS found him unconscious on the ground with critically low blood glucose levels (17 mg/dL).

During transport, he received D50, partially improving his condition.

Initial CT scans revealed no acute intracranial issues. Follow-up MRI showed mild restricted brain diffusion in the left frontal and left parieto-occipital regions; EEG indicated generalized slowing in the left hemisphere.

The patient received glucose, glucagon and antibiotics, and was managed by maintaining blood glucose levels between 140-180 mg/dL and comprehensive rehabilitation services. Over the next few days, the patient regained full strength of his right side and speech improved as well.

Discussions: Hypoglycemia-induced cerebral injury is a rare but critical condition that can mimic stroke-like symptoms. Prolonged hypoglycemia can lead to brain dysfunction due to inadequate glucose supply to neurons. The patient's profound aphasia and hemiparesis were likely consequences of this metabolic insult. Management primarily involves normalizing blood glucose levels to prevent further brain injury. Close monitoring and prompt treatment with glucose and glucagon as well as other medications are crucial. This case highlights the importance of considering hypoglycemia as a potential cause of neurological deficits, especially in patients with diabetes. Early diagnosis and treatment can lead to significant recovery, as demonstrated by the patient's progress at Burke Rehabilitation. It underscores the need to investigate all possible causes of neurological symptoms, even in patients with complex medical histories.

Conclusions: This case illustrates how hypoglycemia-induced cerebral injury can manifest with stroke-like symptoms, emphasizing the significance of comprehensive evaluation in patients presenting with neurological deficits. Timely recognition and management, including glucose correction and supportive care, are essential for favorable outcomes.