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Stroke mimic from hypoglycaemia — SCE Neurology MCQ

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EasyStrokeStroke mimic from hypoglycaemiaSCE Neurology

A 48-year-old woman presented with acute aphasia and right weakness in a patient treated with insulin. On examination, she was sweaty and drowsy with capillary glucose 1.9 mmol/L. Initial investigations showed: symptoms resolved after intravenous dextrose; CT was normal. What is the most likely diagnosis?

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Correct answer: A — Stroke mimic from hypoglycaemia

Stroke mimic from hypoglycaemia is the best answer because the vignette describes Stroke mimic from hypoglycaemia: hypoglycaemia can mimic stroke and should be excluded immediately. Cerebral venous sinus thrombosis is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Thalamic stroke and Locked-in syndrome are less appropriate because they would require different localisation, timing or test findings; Subarachnoid haemorrhage would fit a different syndrome. Clinical pearl: TIA is less likely when correction of glucose reverses the deficit.

Reference: NICE NG128; National Clinical Guideline for Stroke; DVLA Assessing fitness to drive