低血糖による一過性片麻痺の1例

TRANSIENT HYPOGLYCEMIC HEMIPLEGIA DUE TO INSULIN AUTOIMMUNE SYNDROME : A CASE REPORT

　低血糖による中枢神経症候は多彩であるが，片麻痺ををすることは稀である。我々は低血糖時に一過性の片麻痺をきたした症例を経験したので報告する。

　症例は80歳女性で，早朝空腹時の行動異常に加えて，一過性の片麻痺をきたしたため入院した。入院後も同様に低血し糖時に片麻痺をきたし，ブドウ糖の静注により改善した。発作時脳波では全般性に徐波が出現していたが，発作後は正常化していた。神経放射線学的検査で異常はなく，血中インスリンが高値を示し，インスリン自己免疫症候群と．診断された。

　低血糖による片麻痺の発生機序，その脳波所見につき着干の文献的考察を加えた。

Hypoglycemia causes a variety of neurologic symptoms, and yet it is rarely responsible for such a sudden, focal neurologic deficit as hemiplegia. Herein we described a rare case of what was be-lieved to be transient hypoglycemic hemiplegia.

An 80-year-old woman was admitted to the hospi-tal on June 10, 1988, following frequent episodes of abnormal behavior and transient weakness of the right extremities. These symptoms, similar to those of cerebrovascular diseases, characterristcally occured early in the morning and disappeared after breakfast. On admission no definite abnormalities were disclosed on neurologic examination. Neuro-radiolodical evaluations by CT, cerebral angiogra-phy and single photon emission CT failed to de-monstrate abnormalities. The patient remained stable until the following morning, when she sud-denly became restless and confused and developed total aphasia and the right hemiplegia. The blood sugar was estimated to be 34 mg/dl and electroen-cephalogram (EEG) showed continuous slow wave activities involving the bilateral fronto-parietal re-gion. Intravenous injection of glucose solution in-stantaneously resulted in disappearance of both ne-urologic symptoms and EEG abnormality. Serum insulin level was found extremely increased rang-ing from 7000 to 8000 μU, eventually leading to a diagnosis of insulin autoimmune syndrome.

Hemiplegia due to hypoglycemic attack was re-viewed in the literature, and the pathogenesis and EEG findings were also discussed.