Hypoglycaemia can cause focal weakness, speech disturbance and confusion that look exactly like a stroke, and occasionally severe hyperglycaemia does the same. A capillary glucose takes seconds and is part of every acute stroke assessment.
Correcting a low glucose may resolve the deficit, and thrombolysing a hypoglycaemic patient exposes them to bleeding risk for no benefit. Recheck after correction before deciding the deficit is vascular.
- Measure capillary glucose in every patient with a suspected acute stroke.
- Treat hypoglycaemia promptly and reassess the neurological deficit afterwards.
- Ask about insulin, sulfonylureas and missed meals in anyone with sudden focal signs.
- Do not let glucose correction delay imaging if the deficit persists.
Why it matters
The simplest test in the pathway prevents both missed hypoglycaemia and unnecessary thrombolysis.
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