Hyperglycemia Presenting as Left Middle Cerebral Artery Stroke: a Case Report

Abstract

Background and Purpose—Hyperglycemia is an important diagnostic differential and has been reported to cause focal neurological deficits masquerading as stroke. Discussion of hyperglycemia as a stroke
mimic has been sparse in the era of diffusion weighted imaging, but remains an important mimic.
Case Summary—A 67 year-old right-handed woman with presented with lethargy, global aphasia, left
eye deviation and right hemiparesis. She received IV t-PA for left MCA syndrome and transferred for possible intervention. Initial labs showed a glucose 825mg/dL. MRI/MRA brain was negative for acute stroke
with patent vessels, but abnormalities on MRperfusion. The patient was admitted and treated with medical
resuscitation including IV fluids and an insulin drip. After normoglycemia was achieved the patient's neurological deficits resolved. EEG on day one of hospitalization showed left hemispheric slowing that subsequently normalized on continuous recording.
Conclusion—We report a case of hyperglycemia clinically mimicking a left MCA syndrome reversed
with medical management possibly explained by metabolic demand-blood flow coupling of inactive tissue
rather than hypoperfused tissue at risk of infarction.