Endocrine Abstracts

Introduction: Hypoglycemia is common in people with diabetes who aim to achieve strict glucose control. The neurologic manifestations of hypoglycemia are mostly reversible and includes behavioral changes, difficulty in concentration, confusion, loss of fine motor functions, and seizures. Herein we have presented a case who was pregnant and experienced severe hypoglycemia which led to permanent ataxia.

Case: A 26-years-old female patient was brought to our emergency room by her husband because of being found unconscious. She was 10 weeks of pregnant and had history of T1DM for 13 years. At the time of admission her plasma glucose level was 23 mg/dl. In the initial physical examination she was lethargic, blood pressure was low with tachycardia while body temprature was normal. In the obstetric USG, the fetus was alive. In the labaratory examination, she had normal kidney and liver function tests, electrolytes, thyroid function tests, and vit. B12 levels. After her blood glucose returned to normal, complete neurologic examination was made. Her pupils were reactive, tendon reflexes were normal but she was dysarthric. On the second day, dysarthria continued. We realized she had gait disturbace and on cordination tests she had severe dysmetria in all four limbs (finger to nose and heel to shin). Cranial MRG and EEG didn’t reveal any pathology. With short acting anologue and NPH insulin, her blood glucose levels were within the target range but her dysartria and ataxia persisted upon discharge on the 12 th day. One month after discharge, she still had moderate gait disturbance and slow speech in the control visit.

Conclusion: Cerebellar dysfunction is a rare complication of hypoglycemia and may occur in patients with altered cerebellar glucose kinetics.Differential diagnosis involves hematoma, cerebellitis, drug or alcohol ingestion, Wernicke encephalopathy, vit. B12 deficency, and ataxia telengiectasia. Reconsideration of therapy and glycemic targets and supportive therapy is warrented.