IT IS well known that hypoglycemia can produce focal neurological signs mimicking acute cerebrovascular disease.1,2 But ascertainment of the diagnosis of transient hypoglycemia may often be difficult. The following case illustrates the utility of CSF glucose levels in establishing pathogenesis, based on delayed and prolonged depression of CSF glucose when serum glucose is depressed only transiently.
Report of a Case
A right-handed 84-year-old woman, with a history of treated hypertension, came to the St Louis City Hospital emergency room (Figure, point 1) "confused" and with "slurred speech," noticed since the previous evening. She was awake and somewhat agitated and had nonfluent aphasia. She could name common objects and repeat, "It's a pretty day," but had difficulty repeating "no ifs, ands, or buts." There was difficulty in following detailed commands. The remainder of the neurological and medical examination results were unremarkable.In the emergency room, serum chemistry determinations were as
Gruber AB. Low CSF Glucose Level (Hypoglycorrhachia) in Symptomatic Hypoglycemia. JAMA. 1982;247(10):1461. doi:10.1001/jama.1982.03320350065034
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