Clinical manifestations and outcome of transient focal neurologic deficits (TFND) associated with hypoglycemia were evaluated in 44 children with insulin-dependent diabetes mellitus observed retrospectively during a 5 year period at the University of Trieste, Italy. Symptoms included transient hemiparesis in 54 episodes, usually during sleep, and alternating right- and left-sided in 3; aphasia in 16 episodes; and preceded by a brief convulsion in 8 episodes. Duration of episodes was <2 hrs in 30, 2-12 hrs in 13, and >12 hrs in 2. Hypoglycemia was documented in 26, and in 18 of these episodes, symptoms did not resolve promptly after sugar administration. The long-term outcome was benign, no patient having persistent neurologic abnormalities and none developing migraine at follow up. Invasive tests were not considered mandatory. [1]
COMMENT: Transient focal neurologic deficits in children with diabetes are often but not invariably asociated with hypoglycemia and their long-term outcome is good. Alternative causes for an episodic hemiparesis in diabetes include vascular spasm, hemiplegic migraine, and Todd’s paresis.