Transient hypoglycemic paraparetic syndrome in an elderly patient.

An elderly diabetic patient sustained a transient hypoglycemic paraparetic episode that was attributed to inappropriate administration of glyburide. There were no other predisposing causes to account for the transient hypoglycemia. The predominant clinical signs were paraparesis of the lower extremities, with the right side more affected than the left. The patient's paraparesis cleared within two hours after administration of 50 mL of 50 percent glucose intravenously.The management of a paraparetic syndrome should include an appraisal of all the predisposing factors and their correction. The mechanism that was deemed responsible for the patient's transient hypoglycemic paraparetic syndome was loss of cerebrovascular autoregulation in a vulnerable area (the vertebral-basilar artery distribution). In the elderly patient tight control of blood glucose levels should be avoided in view of the potential development of hypoglycemia and brain injury.