Hypoglycemic hemiparesis as stroke mimic with transient splenial lesion and internal capsule involvement: A reversible clinico-radiological concurrence

Abstract

Hypoglycemia presents with a spectrum of neurological manifestations ranging from lightheadedness to confusion and coma. We report here the case of a 61-year-old woman with right hemiparesis presenting within the window period for stroke thrombolysis. MRI brain showed diffusion restriction in posterior limb of left internal capsule and splenium. Patient had documented hypoglycemia of 38 mg/dL. Patient's hemiparesis resolved after glucose correction, and radiological findings completely resolved after 10 days. We present this case to highlight the rare radiological finding of simultaneous internal capsule and splenium involvement in hypoglycemic hemiparesis and the importance to rule out stroke mimics to avoid unwanted thrombolysis.

Keywords: Hypoglycemia; hypoglycemic hemiparesis; internal capsule; stroke mimic; transient splenial lesion.

Figure 1

(a) MRI brain showing diffusion restriction in the left posterior limb of internal capsule and splenium (white arrows); (b) with corresponding ADC fall (white arrow heads); (c) axial FLAIR image showing no signal change; (d-f) follow-up MRI brain showing complete resolution of abnormal signals