以偏瘫为主要表现的低血糖脑病误诊为脑梗死13例分析

目的分析以偏瘫为主要表现的低血糖脑病与其他低血糖脑病有何异同。方法将以偏瘫为主要表现的低血糖脑病13例设为观察组，其他低血糖脑病69例设为对照组，从一般资料和临床表现两方面进行分析。结果观察组平均年龄，既往合并高血压或脑梗死病人数均高于对照组（P〈0．05）；观察组低血糖及意识障碍程度均明显优于对照组（P＜0．05）；观察组颅内动脉中重度狭窄人数明显多于对照组（P〈0.01）。结论以偏瘫为主要表现的低血糖脑病多见于高龄、既往有高血压或脑梗死、昏迷较浅、血糖降低较轻、颅内动脉有中重度狭窄的糖尿病病人。     

低血糖性偏瘫8例报告

糖尿病是一种常见病，而低血糖合并孤立局灶的神经系统体征，以往临床上少见，且常被误诊为急性脑血管病，而延误诊治。现将我科89年一95年诊治的8例低血糖一过性偏瘫报告如下。1临床资料1.1一般资料：8例低血糖偏瘫病人男性5例，女性3例，发病年龄40～76岁平均年龄56岁，均有糖尿病史。病程半年～10年左右。既往：高血压病史2例，心脏病者2冽。脑血管病史2例，慢性支气管炎肺气肿1例，冠状动脉硬化性心脏病合并脑血管病1例。8例中7例临床确诊为11型糖尿病，回例临床确诊为隐性糖尿病。7例长期服用降糖药物。l例饮食控制，发病前有感染史4例…     

2型糖尿病并低血糖偏瘫25例分析

糖尿病引起的低血糖偏瘫酷似脑血管病引起的偏瘫。通常发生于接受胰岛素或口服降糖药治疗的糖尿病性低血糖患者，亦可发生在其它原因所致的低血糖病例中。多伴看失语，意识不清。两者在临床工作中极易误诊。现将我科1995～2004年收住的25例病人分析总结如下。     

糖尿病低血糖后脑梗死32例临床研究

糖尿病低血糖昏迷是临床上常见的昏迷 ,其主要原因为降糖药物所致。而昏迷后经抢救神志转清 ,恢复如常。但部分病人在 2周内又出现脑梗死引起偏瘫等症状 ,故称为糖尿病低血糖后脑梗死。本文收集近 10年来因低血糖昏迷抢救的 80例病人 ,其中发生脑梗死的 3 2例进行临床、ＣＴ研究 ,现总结如下 :1　资料与方法1 1　一般资料　 80例糖尿病低血糖昏迷患者为 2型糖尿病 ,发生脑梗死 3 2例 ,其中男 2 0例 ,女 12例 ,年龄 64～ 75岁 ,平均 66岁。糖尿病患病时间最短 1年 ,最长 12年 ,平均 8年。平时治疗用药情况 :以优降糖为主治疗 12例 ,优降糖和…     

低血糖性偏瘫:二例报告及临床复习

短暂性偏瘫而意识清楚,是一种认识不够的低血糖表现。当低血糖伴有心动过速、大汗及精神状态改变等肾上腺素能释放症状时,诊断较简单。但某些低血糖病人仅表现局灶性神经体征时,则难以确诊。本文报道二例低血糖性偏瘫(HH)病人。     

貌似急性脑血管病的低血糖偏瘫二例

貌似急性脑血管病的低血糖偏瘫二例孙立臣，王淑兰，王兵，杨松伟低血糖引起的偏瘫临床少见。甚易误诊为急性脑血管病，为了提高对本病的认识，现报告２例如下。例１女，６０岁。因多饮、多尿、乏力半年，诊断为Ⅱ型糖尿病入院。高血压史３年。入院时血糖２１．７３ｍｍｏ...     

低血糖性偏瘫9例报告

低血糖性偏瘫极易误诊为急性脑血管病，为提高对本病的认识，现将我院自１９９８年１月～２００１年６月共收治的９例低血糖性偏瘫患者报告如下：1 临床资料 本组９例，男６例，女３例。年龄６１～７９岁，平均６９．３岁。9例均有糖尿病史，３例有高血压病史，２例有脑梗死病史，９例均在发病前服降糖药。出现意识障碍（昏睡或昏迷）８例，伴抽搐３例。均有偏瘫，其中右侧偏瘫６例，左侧偏瘫３例。偏瘫性质无特异性，既有弛缓性偏瘫，又有痉挛性偏瘫。巴彬斯基氏征1例，阳性８例，中性１例。血糖０、６～２．７ｍｍｏｌ／Ｌ，平均１．５ｍ…     

低血糖性偏瘫临床探讨

低血糖可表现为偏瘫。大部分病人缺乏饥饿感及恶心、呕吐、出汗、心悸、面色苍白等交感神经兴奋症状 ,而直接表现为突发偏瘫或进行性偏瘫伴意识障碍 ,常误诊为急性脑血管病。若未及时处理可造成不可逆的神经功能损害。现将我院 1 988～ 1 998年月 1 0年间 1 3例低血糖性偏瘫报告如下 :　　临床资料 :本组 1 3例中 ,男 7例、女 6例 ,年龄 50～ 80岁 ,平均 68.1岁。 9例有糖尿病史 ,约占同期住院糖尿病病人的 0 .1 % ,均长期口服降糖药或注射胰岛素 ;误服降糖药、胰岛细胞瘤及晚期巨大肝癌各 1例。 1 3例均表现为中深昏迷伴偏瘫 ,其中左侧 4例…     

以偏瘫为主要表现的低血糖脑病误诊为脑梗死13例分析

目的分析以偏瘫为主要表现的低血糖脑病与其他低血糖脑病有何异同。方法将以偏瘫为主要表现的低血糖脑病13例设为观察组,其他低血糖脑病69例设为对照组,从一般资料和临床表现两方面进行分析。结果观察组平均年龄,既往合并高血压或脑梗死病人数均高于对照组(P<0.05);观察组低血糖及意识障碍程度均明显优于对照组(P<0.05);观察组颅内动脉中重度狭窄人数明显多于对照组(P<0.01)。结论以偏瘫为主要表现的低血糖脑病多见于高龄、既往有高血压或脑梗死、昏迷较浅、血糖降低较轻、颅内动脉有中重度狭窄的糖尿病病人。     

糖尿病低血糖性偏瘫临床分析

目的探讨糖尿病低血糖性偏瘫的发病机制、诊断和治疗。方法回顾分析21例糖尿病低血糖性偏瘫患者的临床资料。结果患者多为老年人,存在明显诱因,多无典型低血糖表现,及时静推高渗糖,症状可较快缓解。结论老年人糖尿病出现偏瘫应详细询问病史,急查血糖,以尽快诊断及时治疗。     

Hypoglycemic hemiplegia: a report of three cases]

Hemiplegia is a rare complication accompanied with hypoglycemia. We reported three cases of hypoglycemic hemiplegia (HH). Case 1: A 74-year-old female had medication for diabetes mellitus (DM). She had right hemiplegia and aphasia. Case 2: A 72-year-old male had DM, and was admitted to our hospital having loss of consciousness and right hemiplegia. Case 3: An 82-year-old female suffered from consciousness disturbance with tetraplegia, and had left hemiparesis later. She had no DM, but suffered from iatrogenic hypoglycemia. The brain CT of these three cases showed atrophy, and MRI demonstrated multiple infarction. The angiography of case 1 showed the stenosis of bilateral internal carotid artery and the origin of the left vertebral artery. The angiography of case 2 showed severe stenosis of the left internal carotid artery. The cases above had hypoglycemia at admission. The value of the case 1 was 48 mg/dl, case 2 was 35 mg/dl and case 3 was 38 mg/dl. But these symptoms of the three cases disappeared rapidly after glucose infusion. The literature regarding HH was reviewed, and the pathogenesis was discussed. We emphasize the importance of checking blood sugar levels for the emerging patients with hemiplegia, because it is difficult to discriminate by clinical history or neurological findings.     

Hypoglycemic coma associated with brain infarcts.

Hypoglycemic hemiplegia may lead to a mistaken diagnosis of stroke, although the symptoms resolve with correction of the hypoglycemia. We report a 27-year-old white man with insulin-dependent diabetes who developed right hemispheric infarcts and left hemiplegia associated with hypoglycemic coma. This report discusses the possible role of hypoglycemia in causing the stroke.     

A psychiatric study of patients referred with a diagnosis of hypoglycemia.

Five-hour oral glucose tolerance tests (GTTs) differentiated 30 volunteer patients who considered themselves hypoglycemic into three major groups: those who had reactive hypoglycemia, those who were normal, and those who had diabetes. Clinical psychiatric evaluation and Minnesota Multiphasic Personality Inventory testing revealed that half of the 30 patients were experiencing a current psychiatric disorder, usually depression. Hysterical personality traits were also noted in many of the patients. The idea that reactive hypoglycemic patients have specific personality characteristics was not substantiated by the authors' data. They hypothesize that some patients with psychiatric illness may have their symptoms erroneously attributed to incidental GTT findings.     

糖尿病患者发生低血糖脑病的预后影响因素分析

目的 探讨影响低血糖脑病预后的因素。方法 根据标准将2011年1月～2014年9月收治的86例低血糖脑病患者纳入研究,经神经功能缺损评分(NIHSS)、静脉注射推60 mL 50%高渗糖、血糖检测及其他必要治疗后观察患者的预后,分析影响患者预后的因素。结果 对低血糖脑病预后相关的影响因素进行非条件Logistic回归分析显示,与该病预后相关的因素有4项:高龄、发病时血糖水平高、低血糖持续时间长、肾功能异常。结论 影响低血糖脑病患者预后的因素有患者年龄、低血糖的程度、低血糖持续的时间及患者的肾功能,要改善低血糖脑病患者的预后,必须及早发现及纠正低血糖,同时改善肾功能。     

Hypoglycemic hemiplegia: two cases and a clinical review

Hypoglycemic hemiplegia mimics cerebrovascular disease. Two patients are reported who experienced multiple attacks of transient hemiplegia associated with hypoglycemia and who were initially diagnosed as having transient ischemic attacks. In both, angiography was normal and the attacks resolved with reduction of insulin dose. Recognition of hypoglycemia as the cause of transient hemiplegia is important, often obviating the need for cerebrovascular evaluation.     

低血糖脑病的临床及脑部磁共振特征

目的探讨低血糖脑病的临床及脑部磁共振特征。方法回顾分析69例低血糖昏迷患者的临床、脑磁共振（MRI）成像资料。结果低血糖昏迷诱因较为复杂,常见的为进食减少、腹泻、上呼吸道感染、降糖药物应用不当等。临床表现复杂多样,除意识障碍外,还可表现为偏瘫、四肢瘫、凝视麻痹等,多数伴有Babinski征。69例患者中有18例出现脑MRIDWI异常高信号病灶,病灶主要累及海马、基底节、大脑皮质以及皮质下白质,多为对称性损害。3个月后随访,不伴有脑部MRI损害的患者预后良好率明显高于伴有脑部MRI损害的患者（94．12％对22．22％;P=0．0011）。伴有脑部MRI损害者有10例患者预后不良,其中9例（90％）发生于皮质受累患者。结论低血糖脑病临床表现不具有特异性,对于昏迷患者,应当考虑到低血糖的可能。降糖药物应用不当为低血糖脑病的主要诱发因素。脑部MRI要优于脑部CT检查,其中DWI序列对于检测低血糖所致的脑部损害有着非常重要的意义。皮质受累者预后不良。     

Hypoglycemia masquerading as cerebrovascular disease (hypoglycemic hemiplegia)

Hypoglycemia produced hemiplegia with right-sided predilection in 16 patients initially suspected of having suffered a stroke. Fifteen patients had no demonstrable brain disease, and the hemiplegia cleared rapidly once the hypoglycemia was corrected. Invasive investigations such as carotid arteriography are not required in most patients. The features of hypoglycemia hemiplegia suggest that a selective neuronal vulnerability and not underlying focal brain disease is responsible in most cases.     

Hypoglycemia reduces the blood-oxygenation level dependent signal in primary auditory and visual cortex: a functional magnetic resonance imaging study

Studies of the effects of hypoglycemia on the brain using neurocognitive testing have suggested that mainly complex functions subserved by secondary and tertiary cortex are affected by mild to moderate hypoglycemia and that intensively treated patients with Type I diabetes mellitus (T1DM) may have altered sensitivity to the central nervous system effects of hypoglycemia. Functional magnetic resonance imaging provides a sensitive, regionally-specific probe of possible neurophysiologic changes related to hypoglycemia in the brain. Eleven intensively-treated T1DM patients and 11 matched non-diabetic controls took part in a 2-day protocol in which functional magnetic resonance imaging (MRI) was used to measure changes in the patterns of brain activation produced by simple auditory and visual stimuli in different conditions. On one day, participants were euglycemic the entire time. On the other day, an initial 50-min euglycemic period was followed by a 50-min hypoglycemic period. Results indicated that hypoglycemia reduced the amplitude of the blood-oxygenation level dependent response in primary auditory and visual cortex to simple auditory and visual stimuli. The latency and duration of the transient hemodynamic response function were not affected. Responses to hypoglycemia were similar in diabetic and non-diabetic participants. These results suggest that mild to moderate hypoglycemia may alter the balance of blood flow and oxygen extraction when glucose levels are lowered. Intensively-treated T1DM, with its attendant frequent hypoglycemic episodes, did not seem to alter hypoglycemic responses in primary visual and auditory cortex.     

新生儿低血糖脑损伤高危因素分析

目的 探讨新生儿低血糖脑损伤的高危因素及其对预后的影响.方法 回顾性分析2015年1 月至2018 年12 月贵州医科大学附属医院新生儿科收治的235 例新生儿低血糖患儿的临床资料,根据是否发生脑损伤分为脑损伤组和无脑损伤组,比较两组患儿的基本情况、母孕期及新生儿疾病情况、血糖相关资料,经SPSS 24.0统计软件处理...     

Insulin-induced factitious hypoglycemic coma

Hypoglycemia due to the ingestion of oral hypoglycemic agents or injection of insulin is a common way for chronic factitious disorder to present to physicians. Despite this fact, factitious hypoglycemic coma is rare. Because hypoglycemia is potentially fatal, with numerous sequelae, physicians need to be aware of its occurrence and method of detection. A case of chronic factitious disorder presenting as hypoglycemic coma is presented and its implications discussed.