Left Hemiplegia Possibly Due to Glucose Reperfusion Injury after Recovery of Severe Hypoglycemia in a Woman with Type 2 Diabetes Mellitus

Abstract

A 79-year-old woman with type 2 diabetes receiving insulin was rushed to our hospital due to severe hypoglycemia. Glucose was administered, and the consciousness disturbance was promptly improved. A few hours later, conjugate deviation of the eyes to the right and left hemiplegia occurred at a normal glucose level. Cerebral magnetic resonance imaging (MRI) showed hyperintensities of the right posterior limb of the internal capsule and the medial thalamus on diffusion-weighted imaging sequences. However, the changes observed using MRI disappeared completely on the third day, and her symptoms subsequently improved. This may have been a case of glucose reperfusion injury.

Keywords: glucose reperfusion; hypoglycemic encephalopathy; neuronal damage.

Figure 1.

Clinical course after the patient was transferred to our hospital. On the first day after the patient was transferred to our hospital, we monitored her blood glucose level every 30 minutes using a glucose meter. At first, her blood glucose level was 20 mg/dL, and after administering a glucose injection, her blood glucose level was 100-160 mg/dL on the first day. The doses of tPA, edaravone, and argatroban administered were 24×10⁶ units, 60 mg/day, and 60 mg/day, respectively. NIHSS: National Institutes of Health Stroke Scale, tPA: tissue plasminogen activator

Figure 2.

Magnetic resonance imaging (MRI) of cerebral diffusion-weighted imaging (DWI) sequences (A, B) and apparent diffusion coefficient (ADC) maps (C, D). MRI was conducted immediately after the appearance of conjugate deviation of the eyes to the right and left hemiplegia. The hyperintensities of the right posterior limb of the internal capsule and the medial thalamus on DWI (white arrows in A) and hypointensities on ADC map (C) are shown. Changes disappeared entirely on the third day after transfer (B, D).