OBJECTIVE

Hypoglycemia can cause symptoms of neuroglycopenia that can be easily confused with symptoms of greater clinical importance such as stroke. Appropriate differential diagnosis between these 2 processes will be essential for guiding the treatment approach. We report a case in which stroke was initially suspected because hypoglycemia was masked by the incorrect capillary blood glucose (CBG) measurement technique used in treating an itinerant vendor of prickly pears (Opuntia ficus-indica). We studied the effects of prickly pear handling on the CBG levels in 11 vendors before and after they handled the fruit. CBG levels were noticeably higher after the fruit was handled in all cases. Our observations reveal the need to measure both capillary and venous blood glucose levels to rule out hypoglycemia in patients with acute neurological symptoms.