Neuroglycopenia: common etiologies, clinical characteristics, and management

Glucose is primary source of energy substrate for the brain, however, during physiological stresses or other situations with low blood glucose, ketone bodies are another important source of energy for brain. Hypoglycemia has significant impact on the brain and symptomatic hypoglycemia is referred as Neuroglycopenia. Since the brain has minimal endogenous glycogen stores and does not generate glucose intrinsically, it requires a constant supply of glucose from the circulation. Impairment in glucose supply leads to activation of counter regulatory hormone mainly the neuroendocrine response in order to restore the energy requirement. If this response fails to secure the energy demand hypoglycemia can present clinically as headache, stroke, seizure, cognitive impairment or coma. A prompt and accurate diagnosis would allow for more precise treatment and less neuronal damage. This article focuses on common etiology, counter regulatory responses to hypoglycemia, clinical features and management of hypoglycemia.