Sartor-Pfeiffer Jennifer, Lingel Mirjam, Stefanou Maria-Ioanna, Lindig Tobias, Bender Benjamin, Poli Sven, Ziemann Ulf, Fritsche Andreas, Feil Katharina, Mengel Annerose
Department of Neurology and Stroke, Eberhard-Karls University of Tübingen, Tübingen, Germany.
Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Hoppe-Seyler Str.3, 72076, Tübingen, Germany.
Neurol Res Pract. 2022 Aug 22;4(1):36. doi: 10.1186/s42466-022-00201-z.
Hypoglycemia in patients with diabetes mellitus, particularly type 1 can mimic acute ischemic stroke by causing focal neurological deficits. In acute ischemic stroke, the interpretation of emergency imaging including computed tomography with angiography and perfusion is crucial to guide revascularizing therapy including intravenous thrombolysis. However, different metabolic abnormalities and stroke mimics can cause focal hypoperfusion.
We describe two type 1 diabetes patients presenting with acute focal neurological deficits and hypoglycemia, who underwent multimodal computed tomography and follow-up imaging.
Patient 1, a 20-year-old man presented with aphasia and interstitial glucose level of 54 mg/dl. Patient 2, a 77-year-old man presented with aphasia, mild right-sided brachiofacial paresis and interstitial glucose level of 83 mg/dl. On brain imaging, no acute infarct signs were noted. Yet, both had focal left hemispheric cerebral hypoperfusion without large-vessel occlusion or stenosis. Due to persistent symptoms after normalization of blood glucose and despite a perfusion imaging pattern that was interpretated as non-typical for ischemia, both patients underwent thrombolysis without any complications.
Computed tomography perfusion might help to discriminate hypoglycemia with focal neurological signs from acute stroke, but further evidence is needed.
糖尿病患者，尤其是1型糖尿病患者的低血糖可通过引起局灶性神经功能缺损来模拟急性缺血性卒中。在急性缺血性卒中中，包括计算机断层扫描血管造影和灌注成像在内的急诊影像学解释对于指导包括静脉溶栓在内的血管再通治疗至关重要。然而，不同的代谢异常和卒中模拟疾病可导致局灶性灌注不足。
我们描述了两名出现急性局灶性神经功能缺损和低血糖的1型糖尿病患者，他们接受了多模态计算机断层扫描及后续成像检查。
患者1，一名20岁男性，出现失语，间质葡萄糖水平为54mg/dl。患者2，一名77岁男性，出现失语、轻度右侧臂面部轻瘫，间质葡萄糖水平为83mg/dl。脑部成像未发现急性梗死迹象。然而，两人均有左侧半球局灶性脑灌注不足，无大血管闭塞或狭窄。尽管血糖正常后仍有持续症状，且尽管灌注成像模式被解释为非典型缺血，但两名患者均接受了溶栓治疗，无任何并发症。
计算机断层扫描灌注可能有助于鉴别伴有局灶性神经体征的低血糖与急性卒中，但仍需要进一步的证据。
