Stroke mimics commonly confound the clinical diagnosis of stroke. [2]. [QxMD MEDLINE Link]. A patient who is hypoglycemic because of systemic illness or malnutrition may be particularly vulnerable to vitamin deficiency. Our aim was to investigate the clinical and radiological features of patients with hypoglycemia with focal neurological signs (HFNS). 1999. Hypoglycaemia, defined by a plasma glucose of <2.5 mmol/l (45 mg/dl), is the commonest endocrinological emergency and causes a wide range of presenting neurological symptoms including drowsiness, personality change and seizures which mimic other conditions. Google Scholar. Yong, A.W., Morris, Z., Shuler, K. et al. Diabetes Care. Thirteen (20%) mimicked cortical or lacunar stroke. Hypoglycaemia should be part of the differential diagnosis of patients presenting with clinical or imaging features of stroke or TIA. eCollection 2022. [28, 35] In both trials, the intensive treatment groups had an increased incidence of hypoglycemia. Isono O, Araki S, Shiota J, Toyota S, Sugita K: [Hypoglycemic encephalopathy demonstrating generalized multiple cortical infarctions-sequential CT findings]. 1990 Jun. The site is secure. Diabet Med. Helmi L Lutsep, MD is a member of the following medical societies: American Academy of Neurology, American Stroke AssociationDisclosure: Medscape Neurology Editorial Advisory Board for: Stroke Adjudication Committee, CREST2; Physician Advisory Board for Coherex Medical; National Leader and Steering Committee Clinical Trial, Bristol Myers Squibb; Abbott Laboratories, advisory group. Hypoglycemia with focal neurological signs as stroke mimic: Clinical and neuroradiological characteristics Authors Tomohiko Ohshita 1 , Eiji Imamura 2 , Eiichi Nomura 3 , Shinichi Wakabayashi 4 , Hiroshi Kajikawa 5 , Masayasu Matsumoto 6 Affiliations 1 Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan. We hand searched Stroke and Radiology for additional papers and checked reference lists of review articles. 1747493017743797. Poststroke hyperglycemia has been defined using thresholds between 6.1 and 8.0 mmol/L, based on random or fasting blood glucose, 10,16,17 with some studies including patients presenting up to 72 hours from ictus. [QxMD MEDLINE Link]. CAS N Engl J Med. Hypoglycemia with focal neurological signs as stroke mimic: Clinical ... However, risk of hemorrhagic conversion of strokes appears to increase after recombinant tissue-type plasminogen activator (rtPA; see alteplase) administration in patients with diabetes. [QxMD MEDLINE Link]. Patients with acute stroke and hyperglycemia are often kept NPO (nothing by mouth), because of the complicating effects of feeding on the blood glucose level. The prevalence of hyperglycemia, defined as blood glucose level >6.0 mmol/L (108 mg/dL), has been observed in two thirds of all ischemic stroke subtypes on admission and in at least 50% in each subtype including lacunar strokes. Intravenous fluids, such as dextrose 25% in water (D25W) or dextrose 50% in water (D50W), [QxMD MEDLINE Link]. The initial glucose level was 44 mg/dL, but no nausea, vomiting, fever, or cold sweating was reported. The further details are as follows. 11(3):261-71. 2006 Feb 2. Hypoglycemia is abnormally low levels of sugar (glucose) in the blood. Includes DICOM files. Textbooks that do mention imaging findings in hypoglycaemia typically describe bilateral cortical or subcortical changes on CT or MR, but any description at all is missing from all stroke textbooks that we have examined. Clin Neurol Neurosurg. 2008, 66: 101-103. Only three cases with poor clinical outcome showed lesion resolution [22, 26, 36], after 14, 50 and 30 days respectively. Two mechanisms have been postulated to explain the negative influence of hyperglycemia on outcome following stroke: (1) poorer reperfusion due to vascular injury and a loss of vascular tone through oxidation of nitric oxide dependent mechanisms; and (2) increased acidosis, perhaps from lactic acid/acid sensing channels, leading to further tissue injury. There is a large area of low attenuation involving grey and white matter in the right temporal and parietal lobes. 1984 Mar 31. Treatment of hyperglycemia in ischemic stroke (THIS): a randomized pilot trial. Glucose is your body's main energy source. Eighteen patients had normal CT appearances, including 5 with abnormal MR imaging on the same day [11, 21, 25, 27]. [QxMD MEDLINE Link]. Ntaios G, Egli M, Arsovska A, Joye D, Bettex Y, Lauber E, et al. When hypoglycemia is discovered, the glucose level must be brought expeditiously to a normal level. 52(2):280-4. [26]. Two different mechanisms have been suggested as the causes of hypoglycemia-related strokelike episodes. Van den Berghe G, Wilmer A, Hermans G, et al. The literature suggests that the less severe episodes of hypoglycaemia are more likely to cause hemiparesis and smaller corticospinal tract lesions on imaging, thus may be more likely to mimic ischaemic stroke. 140(7):421-4. The patient died the following day. encoded search term (Hyperglycemia and Hypoglycemia in Stroke) and Hyperglycemia and Hypoglycemia in Stroke, Genetic and Inflammatory Mechanisms in Stroke, Magnetic Resonance Imaging in Acute Stroke, COVID Vaccines Safe for Young Children,Study Finds, Preventive Antipyretics, Antibiotics Not Needed in Stroke, Intensive BP Reduction After Stroke Recanalization Harmful, Common Causes of Altered Mental Status in the Elderly. 2006, 27: 1760-1762. Post mortem was not performed. 10.1007/BF00348923. Demchuk AM, Morgenstern LB, Krieger DW, et al. Stroke. Lesions were located anywhere along the corticospinal tracts, including the motor cortex [29], corona radiate [29, 30, 34, 42], posterior limb of the internal capsule [4, 14, 21, 28, 29, 31, 32, 34, 35, 41], pyramidal tracts [25, 37], splenium of the corpus callosum [21, 30, 32, 34, 35, 41] or middle cerebellar peduncles [32, 37]. Shukla V, Shakya AK, Perez-Pinzon MA, Dave KR. Qaseem A, Chou R, Humphrey LL, Shekelle P. Inpatient Glycemic Control: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians. Patients with intermediate outcome showed no lesion resolution. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTE2MjM0MC1vdmVydmlldw==. ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Professor of Radiology, Vice Chair of Education. We included papers that provided any imaging information in patients with hypoglycaemia. [ 2, 3, 4, 5] Signs and symptoms Hyperglycemia in stroke Patients may. Roh JH, Park KW, Kim BJ: Deep gray matter lesion caused by hypoglycemia. 19(3):443-51. Those with bilateral lesions were more likely to present with coma, although two with asymmetrical internal capsule lesions presented with hemiparesis [28, 30]. Cookies policy. Therefore, as standard practice, plasma glucose should be measured in all patients with suspected acute ischaemic stroke to ensure correct diagnosis and prompt treatment of hypoglycaemia. AWY performed literature research, participated in the experimental studies and data analysis, and edited the manuscript. Our aim was to investigate the clinical and radiological features of patients with hypoglycemia with focal neurological signs (HFNS). 2007, 47: 486-488. Hyperglycemia and Hypoglycemia in Stroke - Medscape Different brain regions have different metabolic demands. Acute symptomatic hypoglycaemia is a differential diagnosis in patients presenting with stroke-like neurological impairment, but few textbooks describe the full brain imaging appearances. Snell-Bergeon JK, Wadwa RP. Thirteen days later, she was noted to have left sided weakness by a consultant neurologist and was referred for CT brain imaging (Figure 1) which demonstrated unilateral right temporal and occipital cortical low attenuation with loss of grey-white matter differentiation suggestive of a subacute infarct. Brain CT performed within 9 hours of the estimated time of induction of hypoglycaemia (Figure 2) showed mild generalised cerebral swelling and reduction in grey-white matter differentiation in the temporal and parietal regions bilaterally, worse on the right. Neurology. Hypoglycemic encephalopathy mimicking acute ischemic stroke in clinical ... 130(Pt 6):1626-30. Sixteen patients received intravenous contrast, 10 on CT examination [2–4, 6, 16, 19, 23] and 6 on MR [9, 11, 12, 15, 37, 39]. Furthermore, despite many theories, the mechanism of HG toxicity in acute stroke remains to be clearly elucidated. Clinical features of stroke mimics in the emergency department Serum glucose level and diabetes predict tissue plasminogen activator-related intracerebral hemorrhage in acute ischemic stroke. Rundek T, Gardener H, Xu Q, Goldberg RB, Wright CB, Boden-Albala B, et al. [QxMD MEDLINE Link]. similar attenuation or signal changes to acute ischaemia (Figure 3). PubMed Calles-Escandon J, Garcia-Rubi E, Mirza S, Mortensen A. Klingbeil KD, Koch S, Dave KR. Kumral E, Uncu G, Dönmez I, Cerrahoglu Şirin T, Alpaydın S, Callı C, Kitiş O. Eur Neurol. Differential diagnosis for this imaging appearance would be acute right middle and posterior cerebral artery territory infarction. For patient education information, see eMedicineHealth's Brain and Nervous System Center, as well as Stroke. Results of a large single-blinded multicenter randomized study Med J Aust. Obtain a computed tomography (CT) scan of the head when stroke is suspected. Clinical features of stroke mimics in the emergency department N Engl J Med. 2006, 13: 696-699. 10.1111/j.1464-5491.2004.01185.x. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. J Neurol Neurosurg Psychiatry. This website also contains material copyrighted by 3rd parties. Acute Stroke Diagnosis | AAFP [18] However, earlier animal studies suggested that hyperglycemia has a detrimental effect on the cerebral vascular tree. 2008, 87: 249-250. Richardson ML, Kinard RE, Gray MB: CT of generalized gray matter infarction due to hypoglycemia. Where recorded, glucose levels at presentation ranged from 10 mg/dl to 60 mg/dl (mean 24 mg/dl), and duration of hypoglycaemia was greater than 6 hours in all but two cases [24, 34]. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). In severe cases, hypoglycemia can lead to seizures, neurological problems that may mimic a stroke, or even loss of consciousness. Agrawal N, Jamshed N, Aggarwal P, Ekka M. Severe hypoglycemia masquerading as cerebellar stroke. Article Physicians need to consider a broad differential diagnosis when evaluating a patient presenting with a suspected stroke . Aktuelle Neurologie. Would you like email updates of new search results? [11] may be necessary. Usually the diagnosis of hypoglycaemia would be obvious, but in patients with hemiparesis, unilateral imaging findings could be mistaken for ischaemic stroke. Please enable it to take advantage of the complete set of features! 6 The causes of stroke mimics are diverse and are mainly metabolic, such as hypoglycemia, hepatic encephalopathy, and neurological diseases, such as encephalitis and . CS performed clinical studies and participated in the experimental studies and data analysis, and edited the manuscript JMW is guarantor of integrity of the entire study, conceived of the study concepts and design, performed literature research, performed clinical studies, participated in the experimental studies and data analysis, edited the manuscript, and approved final version for submission. [QxMD MEDLINE Link]. An official website of the United States government. 2007 Jul;45(7):518-22. Ma J-H, Kim Y-J, Yoo W-J, Ihn Y-K, Kim J-Y, Song H-H, Kim B-S: MR imaging of hypoglycemic encephalopathy: lesion distribution and prognosis prediction by diffusion-weighted imaging. Hyperglcemia in acute ischemic stroke: a vascular perspective. Amongst patients imaged sequentially with CT, lesions became more apparent on day 2 or thereafter [2, 3, 5, 6, 9, 13, 15–18, 20, 22, 26]. Chalmers J, Risk MT, Kean DM, Grant R, Ashworth B, Campbell IW: Severe amnesia after hypoglycemia. 10.1007/s00234-009-0544-5. J Neurol Sci. The first episode occurred at home prompting an urgent referral to the TIA Rapid Access Clinic. 2001, 10: 14-20. AJNR Am J Neuroradiol. Patients with acute stroke and hyperglycemia are often kept NPO because of complicating effects of feeding on blood sugar level. Holemans X, Dupuis M, Misson N, Vanderijst JF: Reversible amnesia in a Type 1 diabetic patient and bilateral hippocampal lesions on magnetic resonance imaging (MRI). Rev Neurol (Paris). A stroke occurs when the blood supply to the brain is interrupted by a blocked or burst vessel in the brain. Shotliff K, Prasad A, Millard P. Hypoglycaemia masquerading as a stroke. See Stroke, Hemorrhagic and Stroke, Ischemic. PubMed Acute lesions had restricted diffusion on magnetic resonance or low attenuation on computed tomography, plus swelling; older lesions showed focal atrophy or disappeared, as with ischaemic stroke. Acute hyperglycemia adversely affects stroke outcome: a magnetic resonance imaging and spectroscopy study. BMC Med Imaging. 353 (1-2):98-101. In individuals presenting with low glycemic levels and strokelike symptoms, diabetes mellitus may have been previously diagnosed, and recent changes in the doses of hypoglycemic agents and insulin may have been instituted. Lawson ML, Gerstein HC, Tsui E, Zinman B. Treatment of hypoglycemia beyond the initial therapy depends on the underlying cause. [QxMD MEDLINE Link]. sharing sensitive information, make sure you’re on a federal 8600 Rockville Pike 2000, 55: 1064-1065. 360(13):1283-97. Hypoglycemia presents with a spectrum of neurological manifestations ranging from lightheadedness to confusion and coma. Careers. Intensive insulin therapy in the medical ICU. Van den Berghe G, Schoonheydt K, Becx P, Bruyninckx F, Wouters PJ. Zhonghua Er Ke Za Zhi. In patients presenting with acute hemiparesis, if the diagnosis of hypoglycaemia is not considered, or routine blood glucose measurement not performed, or the symptoms fail to improve with glucose, then brain imaging may be performed. Hypoglycemia Causing Focal Cerebral Hypoperfusion and Acute Stroke ... Second, Gold and Marshall suggest that coagulation defects may be the cause of strokelike episodes. Because hyperglycemia may accelerate the ischemic process in stroke, it is possible that characteristic features of acute stroke will appear on computed tomography (CT) or magnetic resonance imaging (MRI) scans sooner than they would in patients without hyperglycemia. Occasional patients had unilateral cortical abnormalities [17] like our Case 1, difficult to distinguish from ischaemic stroke. J Am Heart Assoc. Diabetes Care. The significant majority of these cases are found in patients with pre-existing diabetes. Generalised cerebral swelling was also described [6, 16, 17, 19, 26]. 10(1):23-30. Hypoglycemia - Symptoms and causes - Mayo Clinic https://doi.org/10.1186/1471-2377-12-139, DOI: https://doi.org/10.1186/1471-2377-12-139. Hypoglycemia with focal neurological signs as stroke mimic: Clinical ... 6 The causes of stroke mimics are diverse and are mainly metabolic, such as hypoglycemia, hepatic encephalopathy, and neurological diseases, such as encephalitis and . Patients in the group receiving intensive therapy required medical attention for hypoglycemia at an incidence of 62 episodes per 100 patient-years. 10.2337/diacare.14.10.922. Hypoglycaemia, defined by a plasma glucose of <2.5 mmol/l (45 mg/dl), is the commonest endocrinological emergency and causes a wide range of presenting neurological symptoms including drowsiness, personality change and seizures which mimic other conditions. 10.1212/WNL.55.7.1064. Pitchaiah Mandava, MD, PhD Assistant Professor, Department of Neurology, Baylor College of Medicine; Consulting Staff, Department of Neurology, Michael E DeBakey Veterans Affairs Medical Center Stroke mimics is a term indicating a pathological condition that shows a stroke-like clinical picture due to a symptom caused by a disease other than cerebrovascular diseases. The DWI performed one day later shows only faint lesion. Stroke. CT of generalized gray matter infarction due to hypoglycemia. Stroke. Terms and Conditions, An informal survey of senior neuroradiologists across the UK (population covered approximately 40 million) revealed that only two were aware of seeing a definite case of hypoglycaemia with imaging findings in recent years, contrasting with the daily imaging of several patients with stroke. In individuals presenting with low glycemic levels and strokelike symptoms, diabetes mellitus may have been diagnosed earlier, and recent changes in the doses of hypoglycemic agents and insulin may have been instituted. 2001 Oct. 32(10):2426-32. Further study is therefore required. Five papers described CT imaging only [2–6], 21 papers described both CT and MR [7–27], and 16 described MR only [28–43] (Table 1). [QxMD MEDLINE Link]. 1981 Jul-Aug. 2(4):366-7. There are areas of cortical low attenuation and swelling in the temporal and parietal lobes bilaterally. Google Scholar. Stroke-Like Conditions - StatPearls - NCBI Bookshelf Accessed: June 4, 2013. Unable to load your collection due to an error, Unable to load your delegates due to an error. Other metabolic abnormalities, such as hepatic or renal failure, may also carry a risk of hypoglycemia. In terms of primary prevention, treatment of diabetes appears to reduce the incidence of atherosclerotic complications. Koppel BS, Daras M: Transient hypodensity on CT scan during hypoglycemia. Treatment of hypoglycemia beyond the initial therapy depends on the condition’s underlying cause. Of these, 11 showed enhancement either of cortical [2, 3, 6, 16, 19] or basal ganglia [12, 15, 16, 23] lesions, between the 2nd and 14th day after presentation. Glucose Regulation in Acute Stroke Patients (GRASP) trial: a randomized pilot trial. Finelli PF: Diffusion-weighted MR in hypoglycemic coma. 1985, 18: 510-512. Other less common patterns included bilateral diffuse periventricular restricted diffusion [5, 24, 27, 33, 42], diffuse cortical diffusion restriction [24], or large pontine lesions [5]. 2005, 65: 175-10.1212/01.wnl.0000167128.14769.7b. 2005 Apr 26. 2001, 18: 761-763. PubMed Central Doherty MJ, Jayadev S, Watson NF, Konchada RS, Hallam DK: Clinical implications of splenium magnetic resonance imaging signal changes. Several case reports describe hypoglycemia mimicking acute stroke or symptoms of transient ischemic attack (TIA). Martini and Kent suggest that, even if an occluded vessel causing stroke is recanalized, effective reperfusion may not be established in patients with hyperglycemia. Permissions for use and reproduction of all figures in print and electronic formats have been granted. Recognition of Strokes in the ICU: A Narrative Review. Identifying Diseases that Mimic Strokes - JEMS The proportion of patients with hypoglycaemia who develop imaging abnormalities, and the proportion of those that mimic ischaemic stroke, are unknown as there are no prospective and complete series of patients with hypoglycaemia all of whom had brain imaging. 1993 Sep 30. Various nonvascular neurological and nonneurological conditions may mimic posterior-circulation stroke, including acute peripheral vestibular dysfunction, acute intracranial hemorrhage, subarachnoid hemorrhage, basilar migraine, hypoglycemia, central pontine myelinosis, postinfectious disorders, tumors, and many toxic and metabolic disturbances.. Thomas A Kent, MD is a member of the following medical societies: American Academy of Neurology, Royal Society of Medicine, Stroke Council of the American Heart Association, American Neurological Association, New York Academy of Sciences, Sigma Xi, The Scientific Research Honor SocietyDisclosure: Nothing to disclose. 2007, 11: R115-10.1186/cc6168. Association of Acute and Chronic Hyperglycemia With Acute Ischemic Stroke Outcomes Post-Thrombolysis: Findings From Get With The Guidelines-Stroke. Neurologists typically do not treat patients with glucose-containing fluids without coadministration of thiamine in order to avoid the possibility of precipitating acute Wernicke encephalopathy or chronic Korsakoff psychosis. Intensive approaches to multiple risk factors in stroke have been suggested, including the following: Reduction of low-density lipoprotein (LDL) - To below 100 mg/dL in diabetic patients, Increase of high-density lipoprotein (HDL) - With fibrates if tolerated, an effect that is especially beneficial in patients with insulin resistance 22 Suppl 2:B35-9. 2003, 55: 174-175. Bottcher J, Kunze A, Kurrat C, Schmidt P, Hagemann G, Witte OW, Kaiser WA: Localized reversible reduction of apparent diffusion coefficient in transient hypoglycemia-induced hemiparesis. The signal/attenuation changes can disappear rapidly. The majority had bilateral, generally symmetrical areas of reduced attenuation on CT or of high signal on T2 or diffusion-weighted imaging (DWI) and restricted diffusion on MR, i.e. 2009, 26: 749-750. Int J Stroke. This is an Open Access article is distributed under the terms of the Creative Commons Attribution License ( [QxMD MEDLINE Link]. Stroke. A 69-year-old right-handed diabetic male with no prior history of transient ischemic attack (TIA) presented with two transient episodes of language disturbance and right hemiparesis on consecutive days. We systematically reviewed the literature to identify how often hypoglycaemia may mimic ischaemic stroke on imaging, common patterns and relationships with hypoglycaemia severity, duration, clinical outcome and add two new cases. Bruno A, Biller J, Adams HP Jr, et al. [29] A study by Lawson et al also found that intensive insulin therapy decreases the extent of early macrovascular disease in young individuals with type 1 diabetes, but there were no effects on the numbers of affected patients or on macrovascular mortality. 2014 Oct-Dec. 3 (4):440-2. [QxMD MEDLINE Link]. These patients (n=24) presented with coma (13 patients), acute hemiparesis and somnolence (9 patients) or acute hemiparesis followed by coma (2 patients) but all recovered completely upon correction of blood glucose, usually within hours of symptom onset. Imaging abnormalities in patients with hypoglycaemia are uncommon but very variable, weakly associated with neurological deficit, and about a fifth mimic acute ischaemic stroke. for: Medscape. 2005, 183: 628-. . 52(1):20-8. However, certain patients whose diabetes is difficult to control or patients who may be experiencing the myriad of complications of diabetes may benefit from consultation with an endocrinologist. The mechanism by which CT scanning and MRI specifically affect the diagnosis or treatment of patients with stroke and hyperglycemia is not clear. In addition, hyperglycemia has been associated with onset of focal neurologic symptoms in mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke (MELAS) syndrome. Typically, hyperglycemia in the setting of acute stroke is treated with subcutaneous insulin on a sliding scale. [32] but patients with stroke were not widely represented in this study. Despite returning the blood glucose to normal, the patient remained comatose and was managed supportively. PubMed 329(14):977-86. We systematically review the literature to identify patterns of imaging abnormalities, the relationship with neurological findings and the depth and duration of hypoglycaemia and determine how often hypoglycaemia might mimic stroke on imaging, and present two cases of CT abnormality in acute symptomatic hypoglycaemia, one of which was initially misdiagnosed as ischaemic stroke, clinically and radiologically. Mori F, Nishie M, Houzen H, Yamaguchi J, Wakabayashi K: Hypoglycemic encephalopathy with extensive lesions in the cerebral white matter. These few patients (n=3) all presented with hypoglycaemic coma and achieved generally good recovery after treatment but had persistent short-term memory deficits. Hypoglycemia - Endocrine and Metabolic Disorders - Merck Manuals ... All patients who survived and had follow-up imaging at least 25 days after the acute hypoglycaemic episode showed diffuse cerebral atrophy [2, 3, 6, 12, 13, 16, 17, 19, 24, 26, 36]. PubMed 2017 Jan 23. Of the 21 CTs performed on the day of admission, only one showed a low attenuation lesion [4], whilst two showed generalised cerebral swelling [17, 26]. In addition, mortality was increased in the groups receiving intensive treatment, but the values did not reach statistical significance in either study. [27]. May 28 2013. 10.1159/000116908. 2001 Mar 28. Studies indicate that treatment of hypertension in patients with diabetes reduces stroke risk by more than 40%. 10.1016/j.clineuro.2005.02.004. Stroke. People with diabetes mellitus may have low blood sugar in the morning due to too. Reactive hypoglycaemia: a rarely considered 'stroke mimic' in non ... Diabet Med. Ischemic Stroke Differential Diagnoses - Medscape Kawai N, Keep RF, Betz AL. The largest case series (n=17) [42], mostly patients with poor outcome, was consistent with the other 40 papers, namely that duration but not degree of hypoglycaemia was related to both clinical outcome and extent of imaging lesions. PubMed Google Scholar. Hypoglycemic encephalopathy mimicking acute ischemic stroke in clinical presentation and magnetic resonance imaging: a case report . Nondiabetic ischemic stroke patients with hyperglycemia have a 3-fold higher 30-day mortality rate than do patients without hyperglycemia. 8, 11, 14, 20 - 24 The two most common stroke mimics are hypoglycemia . Hyperglycemic hyperosmolar state (HHS) can cause focal symptoms including visual loss, focal seizures, and movement disorders. 1 Extensive experimental evidence in stroke models supports that hyperglycemia has adverse effects on tissue outcome, .
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