DOI: 10.12890/2023_003947
Code pseudo stroke – a case of hypokalaemic periodic paralysis mimicking stroke
Authors
ramialhandola@gmail.com
Keywords
Hypokalemic periodic paralysis, Thyrotoxic periodic paralysis, Thyrotoxicosis, Pseudostroke, stroke mimicsAbstract
We present a case of thyrotoxic periodic paralysis (TPP) presenting with stroke symptoms as a harbinger of Grave’s disease. A 61-year-old female presented with symptoms of abdominal pain and fatigue two weeks prior to admission and reported acute diarrhoea and unintentional weight loss. Investigation revealed thyrotoxicosis with undetectable thyroid stimulating hormone (TSH), elevated free T4 and elevated thyroid stimulating immunoglobulin (TSI). On the third day of admission, while undergoing physical therapy, code stroke was called on account of the onset of right-side predominant acute flaccid paralysis of upper and lower extremities, right-side facial droop, dysarthria and hyporeflexia bilaterally. The patient was alert and fully oriented with stable vitals with no increased labour in breathing at room air. An emergent head and neck CT, angiography, and magnetic resonance imaging (MRI) were negative. Serum potassium was 2.7 mmol/l, requiring prompt replacement. The patient’s paralysis and dysarthria improved over the following three days with a complete reversal of symptoms following the correction of serum potassium. Thyrotoxic periodic paralysis can occur in association with any of the causes of hyperthyroidism. It is due to a significant intracellular shift of potassium, subsequently manifesting clinically with hypokalaemia and muscle paralysis.
References
- Lin S-H. Thyrotoxic periodic paralysis. Mayo Clin Proc 2005;80:99–105.
- Glass J, Osipoff J. Thyrotoxic periodic paralysis presenting in an African-American teenage male: case report. Int J Pediatr Endocrinol 2020; 7.
- Antonello IC, Antonello VS, de Los Santos CA, de Almeida N, d’Avila DO. Thyrotoxic hypokalemic periodic paralysis: a life-threatening syndrome. Eur J Emerg Med 2009;16:43–44.
- Kilpatrick RE, Seiler-Smith S, Levine SN. Thyrotoxic hypokalemic periodic paralysis: report of four cases in black American males. Thyroid 1994;4:441–445.
- Ober KP. Thyrotoxic periodic paralysis in the United States. Report of 7 cases and review of the literature. Medicine (Baltimore) 1992;71:109–120.
- Al Khathaami AM, Alsaif SA, Al Bdah BA, Alhasson MA, Aldriweesh MA, Alluhidan WA, et al. Stroke mimics: Clinical characteristics and outcome. Neurosciences (Riyadh) 2020;25:38–42.
- Zhelev Z, Walker G, Henschke N, Fridhandler J, Yip S. Prehospital stroke scales as screening tools for early identification of stroke and transient ischemic attack. Cochrane Database Syst Rev 2019;4:CD011427.
