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February 18, 2000


Question from Maryland, USA:

This is a follow up to a previous question. We experienced almost the exact same situation 4 days ago with our 7 year old son, diagnosed Type 1 16 months ago. He woke up wailing, inconsolable, and incoherent with a blood sugar of 96. After noticing right side paralysis, we administered glucagon and I rushed him to the hospital. The ER doctor almost immediately diagnosed Todd's paralysis due to hypoglycemia as the most likely cause. Further along in the day, as our son recovered his motion, the ER doctor, as well as a pediatric nurse practitioner, stayed with this diagnosis as the mostly likely cause with secondary and tertiary diagnosis of Lyme's disease and TIA. Tests completed to this point consisted of blood work and CT scan both with normal results. That evening a staff pediatrician examined our son and pronounced her diagnosis as a "transient migraine" something or other that pretty much floored us. Presently we are working with our son's endocrinologists to try to get a handle on this as we await his visit to a neurologist. What exactly is TIA? What is this transient migraine whatever? What should we ask the neurologist? What further tests should we push for? Also, please provide sources so that we can better educate ourselves as to these possible diagnosis. [email protected]


T.I.A. is a commonly used abbreviation for Transient Ischemic Attack. This term is usually used to explain temporary disturbances of the central nervous system in older people with hypertension and various forms of vascular disease. Migraine is also a transient cerebral vascular problem which rather rarely causes the same symptomatology; but which is unaccompanied by peripheral vascular disease or high blood pressure.

Hemiplegia [weakness on one side] is really a fairly common complication of severe hypoglycemia in children and young adults and presumably has a somewhat different basis reflecting more a glucose (energy) insufficiency in part of the cerebral cortex rather than a blood vessel problem. It is sometimes accompanied by aphasia [speech impairment] and even coma and can on occasion take as long as a week to resolve.

I don’t think that at this time you need to push for any further tests; the important goal is to make the necessary adjustments to the insulin and dietary regimen to prevent a recurrence. It might be worth having your son wear the GlucoWatch (recently approved by an FDA committee) on his leg at night just for the alarm which could be easily relayed to your room. As to questions for the neurologist perhaps the most important would be to hear his views on the chances of this sort of episode producing a delay in cognitive development.