Hypoglycemia-Induced Pontine Infarction in a Diabetic Male with Basilar Artery Stenosis: Insight into the Mechanisms of Hypoglycemic Stroke

metformin were continued and capillary glucose measurements ranged between 87 and 140 mg/dl. On the second day, he became obtunded with a new right hemiplegia, slurred speech and a National Institute of Health Stroke Scale score of 13. Bedside fingerstick glucose obtained was 42 mg/dl and the blood pressure was 154/82 mm Hg. One ampule of 50% dextrose was given intravenously. Noncontrast CT obtained immediately revealed no acute abnormalities. One hour later, his National Institute of Health Stroke Scale score was 6. Over the next 48 h, the patient experienced little improvement of the residual right-sided motor deficit. On the third day MRI/ MRA demonstrated an area involving the left half of the pons and lower mid-brain showing T 2 prolongation and restricted diffusion consistent with acute infarct. Along with this new pontine infarct ( fig. 1 ), 50% mid-basilar artery stenosis ( fig. 2 ) was also demonstrated on the MRA. Five days later, he was discharged to a rehabilitation facility.