Hypoglycaemia-induced Parkinsonism in a Patient with Diabetes Mellitus and Tuberculous Encephalitis: A Complex Case Report
Hypoglycaemia-induced Parkinsonism is a rare but significant complication of metabolic brain dysfunction, characterised by movement disorders following severe hypoglycaemia. We present a 65-year-old male with a 12-year history of type 2 diabetes mellitus, Autoimmune Haemolytic Anaemia (AIHA), and re...
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JCDR Research and Publications Private Limited
2025-08-01
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| author | Venkatramani Padma Pusapati Lakshmi Chaitanya Varma Sathyapriya Mathisha Ebby Perin Ishai Vannan |
| author_facet | Venkatramani Padma Pusapati Lakshmi Chaitanya Varma Sathyapriya Mathisha Ebby Perin Ishai Vannan |
| author_sort | Venkatramani Padma |
| collection | DOAJ |
| description | Hypoglycaemia-induced Parkinsonism is a rare but significant complication of metabolic brain dysfunction, characterised by movement disorders following severe hypoglycaemia. We present a 65-year-old male with a 12-year history of type 2 diabetes mellitus, Autoimmune Haemolytic Anaemia (AIHA), and recent tuberculous encephalitis who was found unresponsive due to severe hypoglycaemia. Despite intravenous glucose administration, he developed new-onset Parkinsonism, manifesting as tremors, rigidity, and bradykinesia. Neurological imaging revealed hippocampal involvement on Magnetic Resonance Imaging (MRI), while a Dopamine Transporter (DaT) scan demonstrated reduced striatal uptake, confirming a dopaminergic deficit. The patient was managed with basal-bolus insulin therapy, corticosteroids for AIHA, and anti-tubercular treatment, while Parkinsonian symptoms improved with levodopa/carbidopa, trihexyphenidyl, and amantadine. Hypoglycaemia-induced neuronal injury results from metabolic failure, oxidative stress, excitotoxicity, and neuroinflammation, leading to selective neuronal necrosis, particularly affecting the basal ganglia, hippocampus, and substantia nigra. While some cases demonstrate reversible outcomes due to vasogenic oedema, others progress to irreversible neurodegeneration, emphasising the need for stringent glycaemic management and early recognition of neurological sequelae in diabetic patients. |
| format | Article |
| id | doaj-art-15f00a4d25f04d339116fa0183550e22 |
| institution | DOAJ |
| issn | 2249-782X 0973-709X |
| language | English |
| publishDate | 2025-08-01 |
| publisher | JCDR Research and Publications Private Limited |
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| series | Journal of Clinical and Diagnostic Research |
| spelling | doaj-art-15f00a4d25f04d339116fa0183550e222025-08-20T03:15:29ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2025-08-01198OD01OD0510.7860/JCDR/2025/74331.21279Hypoglycaemia-induced Parkinsonism in a Patient with Diabetes Mellitus and Tuberculous Encephalitis: A Complex Case ReportVenkatramani Padma0Pusapati Lakshmi Chaitanya Varma1Sathyapriya2Mathisha Ebby Perin3Ishai Vannan4Professor, Department of General Medicine, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India.Junior Resident, Department of General Medicine, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India.Assistant Professor, Department of General Medicine, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India.Senior Resident, Department of General Medicine, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India.Junior Resident, Department of General Medicine, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India.Hypoglycaemia-induced Parkinsonism is a rare but significant complication of metabolic brain dysfunction, characterised by movement disorders following severe hypoglycaemia. We present a 65-year-old male with a 12-year history of type 2 diabetes mellitus, Autoimmune Haemolytic Anaemia (AIHA), and recent tuberculous encephalitis who was found unresponsive due to severe hypoglycaemia. Despite intravenous glucose administration, he developed new-onset Parkinsonism, manifesting as tremors, rigidity, and bradykinesia. Neurological imaging revealed hippocampal involvement on Magnetic Resonance Imaging (MRI), while a Dopamine Transporter (DaT) scan demonstrated reduced striatal uptake, confirming a dopaminergic deficit. The patient was managed with basal-bolus insulin therapy, corticosteroids for AIHA, and anti-tubercular treatment, while Parkinsonian symptoms improved with levodopa/carbidopa, trihexyphenidyl, and amantadine. Hypoglycaemia-induced neuronal injury results from metabolic failure, oxidative stress, excitotoxicity, and neuroinflammation, leading to selective neuronal necrosis, particularly affecting the basal ganglia, hippocampus, and substantia nigra. While some cases demonstrate reversible outcomes due to vasogenic oedema, others progress to irreversible neurodegeneration, emphasising the need for stringent glycaemic management and early recognition of neurological sequelae in diabetic patients.https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2025&month=August&volume=19&issue=8&page=OD01-OD05&id=21279loss of consciousnessmagnetic resonance imagingmetabolic brain disordersmovement disorders |
| spellingShingle | Venkatramani Padma Pusapati Lakshmi Chaitanya Varma Sathyapriya Mathisha Ebby Perin Ishai Vannan Hypoglycaemia-induced Parkinsonism in a Patient with Diabetes Mellitus and Tuberculous Encephalitis: A Complex Case Report Journal of Clinical and Diagnostic Research loss of consciousness magnetic resonance imaging metabolic brain disorders movement disorders |
| title | Hypoglycaemia-induced Parkinsonism in a Patient with Diabetes Mellitus and Tuberculous Encephalitis: A Complex Case Report |
| title_full | Hypoglycaemia-induced Parkinsonism in a Patient with Diabetes Mellitus and Tuberculous Encephalitis: A Complex Case Report |
| title_fullStr | Hypoglycaemia-induced Parkinsonism in a Patient with Diabetes Mellitus and Tuberculous Encephalitis: A Complex Case Report |
| title_full_unstemmed | Hypoglycaemia-induced Parkinsonism in a Patient with Diabetes Mellitus and Tuberculous Encephalitis: A Complex Case Report |
| title_short | Hypoglycaemia-induced Parkinsonism in a Patient with Diabetes Mellitus and Tuberculous Encephalitis: A Complex Case Report |
| title_sort | hypoglycaemia induced parkinsonism in a patient with diabetes mellitus and tuberculous encephalitis a complex case report |
| topic | loss of consciousness magnetic resonance imaging metabolic brain disorders movement disorders |
| url | https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2025&month=August&volume=19&issue=8&page=OD01-OD05&id=21279 |
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