Case Report

Paralysis in an Adolescent

Authors: Krishan Kumar MD, Faiz Khan MD, Haidee Custodio MD

Abstract

Abstract:An 18-year-old male with a history of diabetes presented with hemiparesis. His serum glucose was low, but did not fit the numerical criteria for hypoglycemia. His symptoms rapidly reversed after glucose infusion. This case illustrates crucial features of hypoglycemia. Symptoms may be atypical in the young adult population and may occur at levels higher than numerical definitions. Clinicians should be vigilant regarding the variability in symptoms of hypoglycemia and serum levels necessary to produce them. Lack of vigilance can lead to delayed critical intervention. Understanding this aspect of hypoglycemia also has implications for training prehospital personnel.

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References

References1. Smeeks F. Emergency Medicine. Available at: www.emedicine.com/emerg/topic272.htm 2006. Accessed September 2007.2. Nimet K, Turgut Y, Tansel B, et al. Cortical visual impairment secondary to hypoglycemia. Neuro-Opthalmology 2005;29:27–31.NimetK]]TurgutY]]TanselB&etal;Cortical visual impairment secondary to hypoglycemia.Neuro-Opthalmology20052927-313. Kossoff EH, Ichord RN, Bergin AM. Recurrent hypoglycemic hemiparesis and aphasia in an adolescent patient. Pediatr Neurol 2001;24:385–386.KossoffEH]]IchordRN]]BerginAMRecurrent hypoglycemic hemiparesis and aphasia in an adolescent patient.Pediatr Neurol200124385-3864. MacDonald JT, Brown DR. Acute hemiparesis in juvenile insulin-dependent diabetes mellitus (JIDDM). Neurology 1979;29:893–896.MacDonaldJT]]BrownDRAcute hemiparesis in juvenile insulin-dependent diabetes mellitus (JIDDM).Neurology197929893-8965. Spallino L, Stirling HF, O'Regan M, et al. Transient hypoglycemic hemiparesis in children with IDDM. Diabetes Care 1998;21:1567–1568.SpallinoL]]StirlingHF]]O'ReganM&etal;Transient hypoglycemic hemiparesis in children with IDDM.Diabetes Care1998211567-15686. Albayram S, Ozer H, Gokdemir S, et al. Reversible reduction of apparent diffusion coefficient values in bilateral internal capsules in transient hypoglycemia-induced hemiparesis. AJNR Am J Neuroradiol 2006;27:1760–1762.AlbayramS]]OzerH]]GokdemirS&etal;Reversible reduction of apparent diffusion coefficient values in bilateral internal capsules in transient hypoglycemia-induced hemiparesis.AJNR Am J Neuroradiol2006271760-17627. Shehadeh N, Kassem J, Tchaban I, et al. High incidence of hypoglycemic episodes with neurologic manifestations in children with insulin dependent diabetes mellitus. J Pediatr Endocrinol Metab 1998;11(suppl 1):183–187.ShehadehN]]KassemJ]]TchabanI&etal;High incidence of hypoglycemic episodes with neurologic manifestations in children with insulin dependent diabetes mellitus.J Pediatr Endocrinol Metab199811183-1878. Limbert C, Schwingshandl J, Haas J, et al. Severe hypoglycemia in children and adolescents with IDDM: frequency and associated factors. J Diabetes Complications 1993;7:216–220.LimbertC]]SchwingshandlJ]]HaasJ&etal;Severe hypoglycemia in children and adolescents with IDDM: frequency and associated factors.J Diabetes Complications19937216-220