低血糖性片麻痺の原因と診断

Hypoglycemic Hemiplegia

低血糖性片麻痺は血糖値低下によって片麻痺をきたす病態で，MRI拡散強調画像で内包後脚に高信号が出現することから，急性期脳梗塞との鑑別が問題となる。低血糖では，内包を含めた白質障害が重要であることが，近年明らかになりつつある。しかしながら，脳全体のグルコース不足にもかかわらず症状が片麻痺となる理由や，左片麻痺と比較して右片麻痺の報告が多い理由については，いまだ明らかでない。

Abstract

Hypoglycemia may cause acute hemiplegia. The most common diffusion-weighted MR imaging finding in patients with hypoglycemic hemiplegia is the hyperintense lesion involving the internal capsule, mimicking acute ischemic stroke. Thus, in patients with acute onset hemiplegia, it is important to differentiate hypoglycemia on arrival by immediate blood glucose measurement. It has recently been shown that hypoglycemic brain injury start in large white matter tracts such as internal capsule and spread throughout the whole brain, including the gray matter. However, it is still unclear why focal signs such as hemiplegia develope in metabolic disorders affecting the whole brain.