Hyperosmolar hyperglycemic state as a stroke mimic

Hyperosmolar hyperglycemic state (HHS) is a medical emergency, characterized by hyperosmolarity, hyperglycemia, and intravascular volume depletion, in the absence of ketosis. The spectrum of neurological manifestations in HHS is diverse, ranging from mild encephalopathy to coma. The common neurological presentations of HHS include encephalopathy, seizures, and hyperkinetic movement disorders. Stroke-like presentation of HHS is less reported. We report the case of an elderly female, with uncontrolled type 2 diabetes mellitus, who presented with left hemiplegia and, on evaluation, she was diagnosed to have HHS. As she was a chronic kidney disease patient, this case posed challenges in fluid management, which forms the corner stone of HHS management, along with insulin administration. She was discharged at the end of 1 week, with a complete resolution of her neurological deficit.