Hypoglycemic Hemiplegia Associated with Reversible Narrowing of the Contralateral Middle Cerebral Artery in a Patient with Adrenal Insufficiency

A 56-year-old man with a 2.5-month history of anorexia developed sweating, weakness, and left hemiple-gia and hemispatial neglect. Brain magnetic resonance imaging detected no abnormalities, but magnetic reso-nance angiography revealed narrowing of the right middle cerebral artery (MCA). The focal neurological signs and narrowing of the MCA resolved after detection and correction of hypoglycemia. Endocrinological examinations indicated adrenal insufficiency. Hemiplegia is a rare but important neurological manifestation of hypoglycemia, although the mechanisms involved remain unknown. Combined hypoglycemia and decreased MCA blood flow associated with vasospasm probably induced regionally severe neuroglycopenia with ische-mia, which presented as focal neurological symptoms.

Automated summary

A 56-year-old man with anorexia for 2.5 months presented with sweating, weakness, left hemiplegia, and hemispatial neglect. Magnetic resonance imaging showed no abnormalities, but magnetic resonance angiography revealed narrowing of the right middle cerebral artery. Neurological symptoms and arterial narrowing resolved after correction of hypoglycemia. Adrenal insufficiency was identified through endocrinological examinations. Hemiplegia is a rare but important neurological manifestation of hypoglycemia, possibly caused by combined hypoglycemia and decreased blood flow leading to regional neuroglycopenia and ischemia.