Background: Hypoglycemia may rarely present as hemiparesis and sometimes, it is difficult
to differentiate from ischemic stroke. When Random Blood Sugar (RBS) value is between 50
and 70 mg% in patients presenting with focal neurological deficit, no guideline exists to consider
the possibility of hypoglycemia before initiating thrombolytic therapy.
Clinical Case: A 58-year-old male, with preexisting illness of diabetes and hypertension diabetes
and hypertension, was brought to the emergency room with acute onset of right hemiparesis and
dysarthria of 90 minutes duration. His NIHSS Score was 9, blood pressure was 150/90 mm of Hg and
RBS was 79 mg% on admission. His CT scan brain was normal and was considered for thrombolysis.
The resident doctor was not aware of previous sugar repeated RBS before thrombolysis, which was
surprisingly 60 mg% 60 minutes after the first RBS. Even though he was a candidate for thrombolysis,
intravenous 25% dextrose was administered considering the possibility of hypoglycemia.
He made a complete recovery within 20 minutes and thrombolytic therapy was withheld.
In diabetic patients with focal neurological deficit and RBS less than 80 mg% on admission, RBS
should be rechecked and in appropriate cases, should be challenged with IV dextrose considering
the possibility of hypoglycemia before commencing thrombolytic therapy.