Journal Article

Hemiparesis and facial droop in an older woman

Kastanakis, Serafim, Anyfantakis, Dimitrios

2022

Overview

Routine serum blood tests were performed (table 1).Table 1 Serum blood test results Investigation Result Normal range Finger stick blood glucose (mmol/L) 2.3 4-6 Serum blood glucose (mmol/L) 2.2 4-6 Haemoglobin A1c (mmol/mol) 45 40-42 Creatinine (μmol/L) 97.2 62-106 Urea (mmol/L) 15.4 3.6-18 Sodium (mmol/L) 139 135-148 Potassium (mmol/L) 4.5 3.5-5.3 Questions What are the differential diagnoses of hemiparesis and facial droop? Hypoglycaemic hemiparesis—hypoglycaemia is a common stroke mimic, and the cause in 2% of presentations for hemiparesis.234567 A serum blood glucose concentration <3.0 mmol/L is indicative of severe hypoglycaemia, which, if neglected, results in brain damage, coma, or death.234568 Confusion, dysarthria, and drowsiness might also be present.9 Sulfonylureas stimulate the secretion of insulin, increasing the risk of hypoglycaemia.9Glimepiride metabolites in patients being treated for renal disease take longer to be excreted, which can lead to severe hypoglycaemia that lasts >24 hours.10 How would you manage this patient? Intravenous dextrose infusion is recommended to correct hypoglycaemia.5 Hemiparesis resolves after normalisation of blood glucose levels.5A CT scan of the brain is necessary to rule out transient ischaemic stroke.1 Learning points Hypoglycaemia is a potential reversible cause of focal neurological symptoms Timely recognition of hypoglycaemia is essential to prevent irreversible neurological deficits and avoid unnecessary investigations (brain CT) or treatments (intravenous thrombolysis, aspirin) Stroke mimics include hypoglycaemia, seizures, sepsis, migraine, brain tumours.

• Publisher: British Medical Journal Publishing Group,BMJ Publishing Group LTD
• Subject: Aged, 80 and over / Aspirin / Blood glucose / Blood levels / Brain cancer / Brain injury / Brain tumors / Computed tomography / Creatinine / Dextrose / Diabetes / Diagnosis, Differential / Drowsiness / Dysarthria / Endgames / Facial Paralysis - diagnosis / Facial Paralysis - etiology / Facial Paralysis - pathology / Facial Paralysis - therapy / Female / Glucose / Glucose - administration & dosage / Glucose - therapeutic use / Headache / Hemoglobin / Humans / Hypoglycemia / Hypoglycemia - complications / Hypoglycemia - therapy / Insulin / Intravenous administration / Ischemia / Kidney diseases / Migraine / Neurological diseases / Older people / Paresis / Paresis - diagnosis / Paresis - etiology / Paresis - pathology / Paresis - therapy / Seizures / Sepsis / Stroke / Thrombolysis / Thrombolytic drugs / Tumors / Womens health