Learning objectives
To show two cases of hemichorea-hemiballism associated with hyperglycemia with typical MRI and CT findings and their evolution
Background
•Hyperosmolar non-ketotic hyperglycemia syndrome is a frequent complication of diabetes mellitus (DM) in older patients,
and has been associated with various neurological abnormalities.
•Hemiballism-hemichorea is an involuntary,
purposeless,
wide amplitude,
and poorly patterned movement disorder; the more common causes are: vascular lesions,
metabolic derangements,
neoplasms,
and infectious diseases of the central nervous system,
being an uncommon manifestation of DM.
• Hyperglycemia-associated chorea and ballism is a syndrome with unique radiological features.
It´s considered benign with good prognosis,
however there are cases with persistence of dyskinesia...
Imaging findings OR Procedure details
Case 1
58 year old man.
•Was admitted for sudden onset of abnormal movement on the right side 7 days before.
•His previous history and general clinical examination were unremarkable,
he had no history of hypertension,
diabetes,
headache,
parkinsonism,
or other neurologic diseases.
He was not on any medication.
•At admission,
his blood glucose level was 212 mg/dl.
Urine analysis was negative for ketones.
Thyroid and liver function tests were normal.
The serum concentrations of heavy metals (copper,
iron) were within the reference ranges.
•On...
Conclusion
Hyperintensity seen on the T1-weighted MR imaging of the brain,
can occur in the acute stage of hemichorea-hemiballism associated nonketotic hyperglycemia.
This characteristic radiological imaging may provide a clue for the early diagnosis of this type of dyskinesia,
potentially reversible.
Recognition of this unique clinical-radiologic manifestation is important because correction of the underlying hyperglycemia will lead to rapid improvement of the hyperkinetic states in most cases
Personal Information
N.
Silva Priegue; Radiology,
Povisa Hospital,Vigo (Pontevedra) SPAIN.
Email:
[email protected]
References
1. H.-J.
Kim W.J.
Moon J.
Oh I.K.
Lee H.Y.
Kim S.-H.
Han; Subthalamic Lesion on MR Imaging in a Patient with Nonketotic Hyperglycemia-Induced Hemiballism;Am J Neuroradiol,
2008;29:526–2.
2.Max Wintermark,
Nancy J.
Fischbein,
Pratik Mukherjee,
Esther L.
Yuh,
and William P.
Dillon;Unilateral Putaminal CT,
MR,
and Diffusion Abnormalities Secondary to Nonketotic Hyperglycemia in the Setting of Acute Neurologic Symptoms Mimicking Stroke;Am J Neuroradiol 25:975–976.
3.Din-E Shan,
Donald M.
T.
Ho,
Chen Chang,
Hung-Chi Pan,
and Michael M.
H.
Teng;Hemichorea-Hemiballism: An Explanation for MR Signal Changes;Din-E...
