Reversible Injury of Internal Capsule and Splenium in a Patient with Transient Hypoglycemic Hemiparesis

Case Report A 78-year-old woman with no history of stroke was taken to the Guro Hospital emergency department after being found dysarthric and less responsive at home. Her husband noted that on the day of admission she developed diaphoresis and tremulousness after not having two consecutive meals, followed by dysarthria, right-sided weakness, and somnolence. She was diagnosed as having type 2 diabetes 5 years before and has remained on gliclazide 80 mg/day. She had no history of hypertension, migraine, seizure, or drug abuse. On admission, she was somnolent but easily arousable to painful or auditory stimuli. She was confused and disoriented to time and place. Vital signs were normal. Initial blood glucose was 38 mg/dl. Other blood works including complete blood count, arterial blood gases, electrolytes, chemistries, blood urea nitrogen, creatinine, and a drug screen were all within the normal range. Initial diffusion-weighted imaging (DWI) perIntroduction Diverse neurological manifestations complicating profound hypoglycemia are well-described, ranging from reversible focal deficits to irreversible coma and death [1, 2] . Among these, transient hypoglycemic hemiparesis is rarely reported and frequently misdiagnosed as stroke or transient ischemic attack (TIA), especially in the elderly patients [3] . We report here a patient with transient hypoglycemic hemiparesis in whom sequential MRI exPublished online: June 29, 2006