Hypoglycemic hemineglect a stroke mimic

Abstract

Acute hypoglycemia may mimic acute ischemic stroke, but to our knowledge this has never been reported as transient hemineglect syndrome. We present a 60-year-old male with known diabetes mellitus who was brought to the hospital as a stroke alert. The patient had undetectable glucose levels upon arrival of emergency medical services (EMS), therefore hypertonic glucose was given. On our assessment in the emergency department (ED)he turned his head to the right side, looking to the right to answer questions when addressed on his left side. The extinction and neglect assessment revealed left-sided extinction on double tactile and visual stimulation. CT perfusion of the brain showed a decreased perfusion in the right cortical area. Given the unclear last known normal, urgent brain magnetic resonance imaging (MRI) was performed; stroke was excluded. The patient was admitted to the Intensive Care Unit where glucose was closely monitored. Electroencephalogram showed absence of seizure or postictal activity. The following morning, the patient returned to baseline and was able to recall the event. The episode was attributed to the severe hypoglycemia because of a recent medication change.

Keywords: Hemineglect; Hypoglycemia; Stroke mimic.

Fig. 1

CT perfusion of the brain showed a perfusion decrease in the right cortical area with VIZ artificial intelligence indicating potentially salvageable ischemic brain tissue in the right hemisphere (Green color) (A, B, C, D). Based on the EMS report the glucose level was undetectable when they measured for the first time (White arrow) and patient was given dextrose intravenously. On the arrival to the hospital patient glucose level was 96. (F). (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)

Fig. 2

MRI of the head did not show acute stroke on T1WI, T2WI, FLAIR and DWI sequences (A, B, C, D) and CTA of the head and neck was negative for large vessel occlusion. (E, F).