SUMMARYHypoglycaemic haemiparesis (HH) is an uncommon but important presentation to the emergency department, and it often mimics stroke and is therefore frequently misdiagnosed by clinicians. The mechanism of haemiparesis is not fully understood. This case outlines a diabetic elderly woman, who had been having frequent hypoglycaemic episodes and presented to paramedics with hypoglycaemia associated with a right-sided haemiparesis. She was immediately transferred to the local stroke centre after presenting to the emergency department. CT and MRI did not fit in with her presenting neurology. Her weakness resolved, after normoglycaemia was achieved with dextrose infusion; however, she was reported to be more sleepy and drowsy than usual. After extensive and costly investigations during her prolonged inpatient stay, her unifying diagnosis was an HH which triggered of a hypoactive delirium.
BACKGROUND
A 58-year-old never-smoker man developed dyspnoea, cough, fevers, weight loss and tremulousness over 4 weeks. He had a brief history of asbestos exposure. Significant medical history included autosomal-dominant polycycstic kidney disease (APKD) and renal transplantation 7 years previously. He took mycophenolate mofetil and tacrolimus immune-suppressants.Examination revealed tachypnoea, a fine right arm tremor, bronchial breathing on the right and a superficial 132 cm non-fluctuant lump over the abdomen. Lymph nodes were impalpable.Screening blood tests showed values of c reactive protein 115 mg/l (NR <6.0), urea 25.8 mmol/l, creatinine 254 umol/l (post-transplant baseline 220e230) and tacrolimus 25.53µg/l (NR 5e10). Autoimmune profile was negative. PCR detected cytomegalovirus (CMV) levels at 31 338 copies/ml. Plain chest radiography showed right upper lobe consolidation ( figure 1A). An abdominal ultrasound scan revealed a normal transplanted kidney.
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