transient hypoglycemia is well known to produce a stroke - like picture with hemiplegia and aphasia . rarely , neuroglycopenia can present as ataxia after a hypoglycemic episode , and prolonged and potentially irreversible deficits may occur . we report a case of a 55-year - old female with diabetes who experienced sudden onset unilateral cerebellar symptoms during a hypoglycemic episode . a previously asymptomatic , 55-year - old diabetic female , came to our emergency with sudden onset of inability to maintain posture and impaired co - ordination in body movements for 8 h. she had difficulty in sitting upright from lying down posture and was unable to walk without support . these complaints were worst at the time of onset and had slightly improved upon presentation . patient was a known diabetic for 10 years on glibenclamide therapy at a dose of 5 mg once daily . she was not previously diagnosed or treated for hypertension , coronary artery disease , and valvular heart disease . she had no history of smoking , alcohol , or any substance abuse . on examination , the patient was conscious , alert , and afebrile with pulse rate of 108/min without any irregularity or asymmetry . patient demonstrated dysmetria on the left side in the form of past pointing on finger - nose testing and abnormal heel knee - shin test . her gait was slow , broad based and she was able to take few steps only without support . a provisional diagnosis of cerebellar stroke was made and a mri of brain was requested . at this stage , she was given 50 ml of 50% dextrose followed by an infusion of 10% dextrose before being shifted for imaging . on re - examination after 20 min of dextrose administration , there was complete resolution of cerebellar signs previously noted at presentation . considering the risk of recurrent hypoglycemia due to long acting sulfonylurea , glibenclamide , the patient was observed clinically in emergency for 24 h with frequent blood glucose testing . neurologic examination of the patient remained normal during her hospital stay and the blood glucose did not fall below 120 mg / dl . a diagnosis of hypoglycemia - induced cerebellar dysfunction was made but a possibility of a transient ischemic attack was also kept . mri showed subtle but diffuse cerebral and cerebellar atrophic changes with no areas of infarction , hemorrhage , or demyelination [ figures 1 and 2 ] . doppler study revealed no atherosclerotic plaques or luminal narrowing in vertebrobasilar or carotid arteries refuting transient ischemic attack for her cerebellar symptoms . the patient was discharged after 24 h and followed up at day 30 with no recurrence of cerebellar complaints subsequently . no hematoma or infarction can be seen mri brain t2 axial image showing mild atrophy bilateral cerebral hemisphere and midbrain . non - ischemic causes account for around 13% of cases with stroke - like deficits . the search of literature revealed cases presenting with severe hypoglycemia with significant cognitive impairment with demonstrated residual features of cerebellar dysfunction after resuscitation . only two case reports are available in which the patients had complete resolution of cerebellar dysfunction , without any evidence of myelinolysis . one of these patients presented with unconsciousness and subsequently developed bilateral cerebellar ataxia which persisted for few months . the other patient presented with sweating , palpitations , and features of bilateral cerebellar dysfunction which resolved after 12 h. none of the reported cases suggest unilateral cerebellar dysfunction without any systemic features suggestive of hypoglycemia . thus , this case highlights a rare manifestation of hypoglycemia and brings to the notice of the physicians that blood glucose measurement must be considered in all patients who present with features suggestive of cerebellar stroke . prompt correction of blood glucose in hypoglycemic patients may completely resolve the symptoms and prevent further neuronal damage .
hypoglycemia is a common presenting feature of diabetes in the emergency department . 
 cardiovascular and neuroglycopenia features are well documented in the literature . 
 we here report a case of 55-year - old female who came to our emergency with clinical features suggestive of cerebellar stroke . 
 laboratory investigations revealed severe hypoglycemia . 
 the cerebellar signs and symptoms improved completely with intravenous dextrose infusion . her mr imaging and doppler of carotid and vertebrobasilar arteries were noncontributory . 
 hypoglycemia causes behavioral changes , confusion , loss of consciousness , and seizures . 
 it is also well known to cause hemiplegia and aphasia . 
 hypoglycemia presenting as cerebellar stroke is rarely reported in the literature . 
 this case highlights an uncommon manifestation of a common clinical condition . 
 physician must rule out hypoglycemia in every stroke patients .