Abstract:
Introduction. Stroke mimics are specific conditions that present with an acute neurological deficiency
simulating acute stroke and constitute approximately 30% of all acute stroke admissions. While often
overlooked, electrolyte disturbance is a rare but important reversible cause of the acute focal neurological
deficit and should remain on the differential diagnosis. In one stroke study, metabolic disorders accounted
for 30% of stroke mimics. Hypokalemia is one of the most common electrolyte abnormalities encountered
in medical practice. An accurate diagnosis can be provided by a careful history and well-timed testing.
Case presentation. An 83-year-old man, presented at the Emergency Department (ED), with first
symptoms of hemiparesis and motor aphasia. Ischemic stroke was preliminarily diagnosed based on acute
onset of clinical manifestation and medical history of hypertension, atrial fibrillation, and recent myocardial
infarction. Before the admission, our patient had diarrhea for two days. On Computer tomography (CT)
patient developed cardiac arrest and it was successfully resuscitated. Brain CT scan showed fusiform
aneurysmal dilatation of the basilar artery. The electrocardiogram showed normal sinus rhythm with a
mildly flattened T-wave. Cardiac markers- troponins were in the reference ranges, Glucose levels
10mmol/l, but serum potassium level was low (1,9mmol/l). The potassium correction was started and the
patient’s neurological deficit rapidly resolved. 24 hours brain CT scan didn’t reveal a new consistent
abnormality. Brain magnetic resonance imaging was performed, also without ischemic lesions. Severe
hypokalemia was diagnosed in our patient.
Discussion. This case illustrates that mimicking hypokalemia can induce a unilateral motor deficit, as stroke
is such a condition being rarely described previously in the literature, but remains an important diagnosis
in the ED. The pathophysiology of unilateral motor deficit in acute hypokalemic hemiparesis remains to be
unknown. Previously, only one case was reported with hemiparesis due to severe hypokalemia.
Conclusion. We present an atypical case of hypokalemia which induces hemiparesis. So, physicians should
be alert about these conditions. The correct diagnosis can be lifesaving.
