Severe hypoglycemia following massive ischemic stroke in a cannabis-addicted patient treated by a beta-blocking agent.

Hantson, Philippe [UCL] Duprez, Thierry [UCL] Di Fazio, Vincent

A 34-year-old woman was admitted to the Emergency Department for altered consciousness and left hemiplegia. Symptoms had probably started more than three hours before hospital admission. She had no medical history, except a systemic arterial hypertension which was efficiently controlled by beta-blocking treatment using bisoprolol. She was heavily addicted to cannabis and had smoked three cannabis cigarettes the few hours preceding hospital admission. Food intake had been normal during the day. Brain computed tomography (CT) followed by CT angiography (CTA ) at admission revealed an occlusion of the distal part of the right internal carotid artery extending to the M1 segment of the right middle cerebral artery (MCA ), with large hypo-intense infarction within frontal, temporal and parietal lobes. The patient was out of delay for any revascularization therapy and the increase in right hemispheric ischemic edema led to a so-called “malignant” MCA stroke requiring decompressive craniectomy 24 hours later (Figure 1). Unexpectedly, blood glucose level felt from 119 mg/dL at admission to 36 mg/dL over two hours. The patient then received 12 g of glucose intravenously, and a second similar administration two hours later after blood glucose had increased to only 60 mg/dL. Continuous infusion of 30% dextrose at a rate of 20 mL/h was necessary for the following 14 hours. Blood glucose level thereafter stabilized around 140 mg/dL and no more glucose or insulin supply was required. Extensive toxicological screening was negative for synthetic cannabinoids, while blood Δ9-tetrahydrocannabinol (Δ9-THC) concentration was 2.3 ng/mL. [...]