低血糖症致交替性偏瘫一例
Clinical Misdiagnosis & Mistherapy(2006)
Abstract
[病例] 女,62岁.因右侧肢体活动障碍4小时入院.确诊糖尿病2个月,一直口服格列苯脲5 mg,1日2次,苯乙双胍50 mg,1日3次.查体:意识清,颈软,心肺听诊无异常,双瞳孔等大等圆,直径2.5 mm,对光反应灵敏,右侧鼻唇沟稍浅,伸舌居中,右侧肢体肌力3级,肌张力正常,右Babinski征(+).脑CT未见异常.入院诊断:①脑梗死;②糖尿病2型.入院后静脉滴注生理盐水、血塞通、甘露醇等,约2小时后症状完全缓解.次日晨5时,病人睡醒后发现左侧肢体活动困难.查体:意识恍惚,双眼球向右侧凝视,左侧肢体肌力0级,肌张力低,左Babinski征、Chadaock征均(+).立即静脉滴注甘露醇等药物,于9时症状完全缓解,11时再次出现右侧肢体完全瘫痪,意识恍惚,双眼向左侧凝视,右Babinski征(+)、Chadaock征均(+).急查血糖为1.3 mmol/L,立即静脉推注50%葡萄糖40 ml,症状很快缓解.停服降糖药,继续静脉滴注5%葡萄糖氯化钠3天,检测血糖正常,症状未再复发.确诊为低血糖脑病.
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