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Chatterjee S, Ghosh R, Biswas P, Das S, Sengupta S, Dubey S, Ray BK, Pandit A, Benito-León J, Bhattacharjee R. Diabetic striatopathy and other acute onset de novo movement disorders in hyperglycemia. Diabetes Metab Syndr 2024; 18:102997. [PMID: 38582065 DOI: 10.1016/j.dsx.2024.102997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND AND AIMS Acute onset de novo movement disorder is an increasingly recognized, yet undereported complication of diabetes. Hyperglycemia can give rise to a range of different movement disorders, hemichorea-hemiballism being the commonest. This article delves into the current knowledge about this condition, its diverse presentations, ongoing debates regarding its underlying mechanisms, disparities between clinical and radiological findings, and challenges related to its management. METHODS PubMed and Google Scholar were searched with the following key terms- "diabetes", "striatopathy", "hyperglycemia", "striatum", "basal ganglia", "movement disorder", "involuntary movement". Case reports, systematic reviews, meta-analysis, and narrative reviews published in English literature related to the topic of interest from January 1, 1950, to October 20, 2023, were retrieved. The references cited in the chosen articles were also examined, and those considered relevant were included in the review. RESULTS Diabetic striatopathy is the prototype of movement disorders associated with hyperglycemia with its characteristic neuroimaging feature (contralateral striatal hyperdensitity on computed tomography or hyperintensity on T1-weighted magnetic resonance imaging). Risk factors for diabetic striatopathy includes Asian ethnicity, female gender, prolonged poor glycemic control, and concurrent retinopathy. Several hypotheses have been proposed to explain the pathophysiology of movement disorders induced by hyperglycemia. These hypotheses are not mutually exclusive; instead, they represent interconnected pathways contributing to the development of this unique condition. While the most prominent clinical feature of diabetic striatopathy is a movement disorder, its phenotypic expression has been found to extend to other manifestations, including stroke, seizures, and cognitive and behavioral symptoms. Fortunately, the prognosis for diabetic striatopathy is generally excellent, with complete resolution achievable through the use of anti-hyperglycemic therapy alone or in combination with neuroleptic medications. CONCLUSION Hyperglycemia is the commonest cause of acute onset de novo movement disorders presenting to a range of medical specialists. So, it is of utmost importance that the physicians irrespective of their speciality remain aware of this clinical entity and check blood glucose at presentation before ordering any other investigations. Prompt clinical diagnosis of this condition and implementation of intensive glycemic control can yield significant benefits for patients.
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Affiliation(s)
- Subhankar Chatterjee
- Department of Endocrinology & Metabolism, Medical College & Hospital, Kolkata, India.
| | - Ritwik Ghosh
- Department of General Medicine, Burdwan Medical College & Hospital, Burdwan, India.
| | - Payel Biswas
- Department of Radiodiagnosis, GNRC Hospitals, Barasat, Kolkata, India.
| | - Shambaditya Das
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGMER & SSKM Hospital, Kolkata, India.
| | - Samya Sengupta
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGMER & SSKM Hospital, Kolkata, India.
| | - Souvik Dubey
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGMER & SSKM Hospital, Kolkata, India.
| | - Biman Kanti Ray
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGMER & SSKM Hospital, Kolkata, India.
| | - Alak Pandit
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGMER & SSKM Hospital, Kolkata, India.
| | - Julián Benito-León
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain.
| | - Rana Bhattacharjee
- Department of Endocrinology & Metabolism, Medical College & Hospital, Kolkata, India.
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Arecco A, Ottaviani S, Boschetti M, Renzetti P, Marinelli L. Diabetic striatopathy: an updated overview of current knowledge and future perspectives. J Endocrinol Invest 2024; 47:1-15. [PMID: 37578646 PMCID: PMC10776723 DOI: 10.1007/s40618-023-02166-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE Diabetic striatopathy (DS) is a rare complication of poorly controlled diabetes mellitus (DM), characterized by hyperglycemia associated with chorea/ballism and characteristic reversible basal ganglia abnormalities on computed tomography (CT) and/or magnetic resonance imaging (MRI). We propose a narrative review of the literature on this topic, currently unknown to most, and about which physicians should be aware. We intend to summarize, critically review, and take to mean the evidence on this disorder, describing its typical features. METHODS We searched Pubmed for English-language sources using the following keywords in the title and the abstract: diabetic striatopathy, hyperglycemic non-ketotic hemichorea/hemiballism, chorea/hemichorea associated with non-ketotic hyperglycemia, diabetic hemiballism/hemichorea, chorea, hyperglycemia, and basal ganglia syndrome. We collected scientific articles, including case reports, reviews, systematic reviews, and meta-analyses from the years 1975 to 2023. We eliminated duplicate, non-English language or non-related articles. RESULTS Older Asian women are more frequently affected. Suddenly or insidiously hemichorea/hemiballism, mainly in the limbs, and high blood glucose with elevated HbA1c in the absence of ketone bodies have been observed. Furthermore, CT striatal hyperdensity and T1-weighted MRI hyperintensity have been observed. DS is often a treatable disease following proper hydration and insulin administration. Histopathological findings are variable, and no comprehensive hypothesis explains the atypical cases reported. CONCLUSION DS is a rare neurological manifestation of DM. If adequately treated, although treatment guidelines are lacking, the prognosis is good and life-threatening complications may occur occasionally. During chorea/hemiballism, we recommend blood glucose and HbA1c evaluation. Further studies are needed to understand the pathogenesis.
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Affiliation(s)
- A Arecco
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, 16132, Genoa, Italy
| | - S Ottaviani
- Section of Geriatrics, Department of Internal Medicine and Medical Specialties, University of Genova, 16132, Genoa, Italy
| | - M Boschetti
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, 16132, Genoa, Italy.
- IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy.
| | - P Renzetti
- IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - L Marinelli
- IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, 16132, Genoa, Italy
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Sperotto R, Ceccarelli L, Tereshko Y, Merlino G, Gigli GL, Valente M. The Possible Precipitating Role of SARS-CoV-2 in a Case of Late-Onset Hemichorea Due to a Hyperosmolar Hyperglycemic State: Case Report and Brief Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1949. [PMID: 38003998 PMCID: PMC10673596 DOI: 10.3390/medicina59111949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/18/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023]
Abstract
Case report: An 83-year-old Italian female developed postural instability and gait disturbance associated with a concomitant hyperosmolar hyperglycemic state. Brain CT and MRI scans detected a lesion in the right putamen due to metabolic derangement. A month later, the patient started suffering from choreic movements along the left side of the body with brachio-crural distribution, approximately three weeks after SARS-CoV-2 infection. She was treated with tetrabenazine with complete resolution of the aberrant movements. Any attempt to reduce tetrabenazine caused a relapse of the symptoms. Discussion: In diabetic patients, choreic syndrome should be considered a rare event with a benign prognosis and favorable response to treatment. It is the result of a condition known as "diabetic striatopathy". The association of new-onset choreic movements, an episode of hyperglycemia, and a basal ganglia lesion is suggestive of this condition. Its pathophysiology remains unclear, and a lot of hypotheses are still debated. SARS-CoV-2 might have played a role in triggering the patient's motor symptoms. Conclusions: Our case report agrees with the general features of those reported in the literature about movement disorders in diabetic patients. The late onset of symptoms and the poor response to treatment seem to be atypical characteristics of the syndrome. Although speculative, we cannot exclude the role of SARS-CoV-2. This case can be added to the literature for further studies and reviews.
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Affiliation(s)
- Roberto Sperotto
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Laura Ceccarelli
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Yan Tereshko
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Giovanni Merlino
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Gian Luigi Gigli
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
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Otaka Y, Harada Y, Sugawara N, Shimizu T, Yasui-Furukori N. Relationship Between Diabetic Chorea and Timing of MRI Findings: A Systematic Review with Case Reports. Int J Gen Med 2023; 16:4465-4476. [PMID: 37808208 PMCID: PMC10557969 DOI: 10.2147/ijgm.s423400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023] Open
Abstract
Background Diabetic chorea is a rare complication of diabetes mellitus for which head MRI is the most common diagnostic imaging modality. Cases have been reported where CT and/or MRI findings are inconsistent or clinical symptoms and imaging findings do not appear simultaneously. We aimed to compile the cases in which imaging findings appeared on MRI retests and to examine in a systematic review whether temporal differences in the appearance of imaging findings correlate with clinical characteristics. Case Presentation An 80-year-old man with type 2 diabetes mellitus came to a hospital with abnormal movements of the left upper and lower extremities. Two days after the first visit, his symptoms flared up, and his head MRI showed an old cerebral infarction and no new lesion. On day 14, he retested T1-weighted imaging and showed a high signal in the right putamen, which was considered diabetic chorea. Blood glucose was controlled with insulin, and the involuntary movements disappeared. Methods PubMed and ICHUSHI were searched to identify patients with diabetic chorea who had undergone MRI retests. Patients grouped by the temporal change in the presence/absence of imaging findings were compared on age, sex, duration of diabetes mellitus, blood glucose level, HbA1c level, side of involuntary movement, time to first MRI, and follow-up MRI. Results Of the 64 cases analyzed, 43 (67.2%) were female. The mean age was 69.0 years. 16 (25.0%) had worsening findings upon MRI retesting, 37 (57.8%) had improvement, and 10 (15.6%) had unchanged findings. There were no significant differences in age, sex, mean blood glucose level or HbA1c at onset among the groups. Conclusion There was no association between the pattern of appearance of imaging findings over time and clinical characteristics, including glucose levels. If initial MRI findings are negative, MRI retesting after a certain time may help diagnose diabetic chorea.
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Affiliation(s)
- Yumi Otaka
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, School of Medicine, Tochigi, Japan
| | - Yukinori Harada
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, School of Medicine, Tochigi, Japan
| | - Norio Sugawara
- Department of Psychiatry, Dokkyo Medical University, School of Medicine, Tochigi, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, School of Medicine, Tochigi, Japan
| | - Norio Yasui-Furukori
- Department of Psychiatry, Dokkyo Medical University, School of Medicine, Tochigi, Japan
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Chen T, Qian Y, Deng X. Triglyceride glucose index is a significant predictor of severe disturbance of consciousness and all-cause mortality in critical cerebrovascular disease patients. Cardiovasc Diabetol 2023; 22:156. [PMID: 37386419 PMCID: PMC10311865 DOI: 10.1186/s12933-023-01893-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/17/2023] [Indexed: 07/01/2023] Open
Abstract
OBJECTIVE The association of the triglyceride-glucose (TyG) index with severe consciousness disturbance and in-hospital mortality in patients with cerebrovascular disease in the intensive care unit (ICU) is unclear. This study aimed to investigate the TyG index's predictive ability on the severity of impaired consciousness and in-hospital mortality in patients with cerebrovascular disease in the ICU. METHOD Patients diagnosed with non-traumatic cerebral hemorrhage and cerebral infarction were extracted from the MIMIC-IV database and analyzed as two cohorts. The association between the TyG index and the severity of patients' impairment of consciousness and in-hospital mortality was analyzed using logistic regression models. Using restricted cubic spline curves, we analyzed potential nonlinear relationships between TyG indices and outcome indicators. receiver operating characteristic (ROC) curves were utilized to evaluate the predictive ability of the TyG index for outcome indicators. RESULT The study's last two cohorts comprised 537 patients with traumatic cerebral hemorrhage and 872 patients with cerebral infarction. TyG index was a significant predictor of the severity of impaired consciousness and in-hospital mortality in patients with cerebrovascular disease, as determined by logistic regression. The risk of severe consciousness impairment and in-hospital mortality increased roughly linearly with increasing TyG index. CONCLUSION The TyG index was found to be a significant predictor for severe impairment of consciousness and in-hospital death in patients with cerebrovascular disease in the ICU, and it provides some predictive value for the severity of consciousness disturbances and in-hospital mortality in cerebrovascular disease patients.
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Affiliation(s)
- Ting Chen
- Department of Neurosurgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650032 China
| | - Yuan Qian
- Clinical Medical Research Center for Obstetrics and Gynecology (Yunnan Joint Key Laboratory), Kunming city of Maternal and Child Health Hospital,Kunming city of Women and Children Hospital, Kunming, Yunnan 650032 China
| | - Xingli Deng
- Department of Neurosurgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650032 China
- Puer People’s Hospital, Puer, Yunnan 665099, China
- Yunnan Provincial Clinical Research Center for Neurological Disease, Kunming, Yunnan, 650032 China
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Diabetic Striatopathy: Parenchymal Transcranial Sonography as a Supplement to Diagnosis at the Emergency Department. Diagnostics (Basel) 2022; 12:diagnostics12112838. [PMID: 36428898 PMCID: PMC9689337 DOI: 10.3390/diagnostics12112838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
Background: Diabetic striatopathy (DS) is a rare condition with a debated pathophysiology; a local metabolic dysfunction is the most likely hypothesis. We present a case of DS mimicking an acute stroke, outline a few uncommon/atypical features, and report for the first time the parenchymal transcranial sonography (pTCS) findings. Case Report: An 86-year-old man, treated for insulin-dependent diabetes, presented at an emergency department because of the occurrence of isolated choreo-athetotic movements in his left limbs with fluctuations in the location, frequency, and duration. The blood glucose level was 569 mg/dL. Both urgent and follow-up brain computed tomography (CT) were negative for recent lesions whereas pTCS revealed hyperechogenicity in the right lenticular nucleus. Subsequent magnetic resonance imaging (MRI) showed T1-weighted hyperintensity in the right putamen with negative diffusion-weighted imaging. The symptoms were responsive to glucose control and haloperidol administration, although they persisted during sleep. Conclusions: Unlike previously described cases characterized by hemichorea and/or hemiballism, our patient presented with a stroke-like onset of unilateral irregular choreo-athetotic movements. Notably, based on CT alone, it would not have been possible to distinguish DS from a stroke. In this scenario, the pTCS hyperechogenicity of the right lenticular nucleus helped to hypothesize a metabolic disorder, which was subsequently confirmed by MRI.
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Oo TZ, Lim WT. Hemichorea as initial presentation of newly diagnosed diabetes and acute lacunar stroke. PROCEEDINGS OF SINGAPORE HEALTHCARE 2022. [DOI: 10.1177/20101058221147766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Hemichorea is one of the spectrums of involuntary, continuous, non-purposeful movement of one side of the body, a choreiform disorder. Hemichorea causes vary and include various inherited or acquired systemic conditions. There might be overlapping pathophysiology where the synergistic effects of uncontrolled hyperglycemia and vascular insufficiency cause an incomplete transient dysfunction of the striatum, leading to hemichorea. We herein describe a patient who presented with hemichorea triggered by hyperglycemia and was incidentally found to have an acute lacunar stroke. She was initiated on insulin with good glycemic control. Secondary stroke prevention therapy with aspirin and statin was also started. Her symptoms improved inpatient after stable glycemic control was achieved. After 3 months, her symptoms had completely resolved. Hemichorea is an unusual initial presentation for newly diagnosed diabetes mellitus or stroke. Hence, recognizing and diagnosing this uncommon disease entity is pertinent to make a timely and accurate diagnosis, which can lead to a rapid clinical response.
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Affiliation(s)
- Than Zaw Oo
- Department of General Medicine, Sengkang General Hospital, Singapore
| | - Wan Tin Lim
- Department of Internal Medicine, Singapore General Hospital, Singapore
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One Side of the Story; Clues to Etiology in Patients with Asymmetric Chorea. Tremor Other Hyperkinet Mov (N Y) 2022; 12:3. [PMID: 35136702 PMCID: PMC8815437 DOI: 10.5334/tohm.675] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/20/2022] [Indexed: 01/18/2023] Open
Abstract
Background: Chorea can be due to a large number of etiologies. Unilateral chorea is classically related to a contralateral structural lesion, e.g. of the putamen or subthalamic nucleus, however, based upon personal impressions, we have observed that systemic disease, in particular metabolic or autoimmune conditions, can also lead to a unilateral or markedly asymmetric presentations. We sought to investigate this impression by reviewing the literature. Methods: A PubMed search was conducted using the terms asymmetric” AND “chorea” OR “hemichorea” OR “unilateral” AND “chorea” OR “monochorea” OR “right greater than left” AND “chorea” OR “left greater than right” AND “chorea” OR “right more than left” AND “chorea” OR “left more than right” AND “chorea” as well as “hemiballismus” NOT “stroke” NOT “infarct” NOT “dyskinesia. A total of 243 sources were felt to meet criteria and were reviewed. Results: The most common etiology of reported hemi- or asymmetric chorea was diabetic non-ketotic hyperglycemic hemichorea/hemiballismus. Other common diagnoses were Sydenham’s disease, antiphospholipid syndrome and drug-induced chorea. The vast majority of patients with hemi- or asymmetric chorea had acquired rather than genetic, degenerative or congenital causes. Conclusion: Despite the potential limitations of our literature review, the evidence presented here supports the observation that the vast majority of asymmetric or unilateral chorea presentations are due to acquired causes, and in this situation an exhaustive search for reversible etiology should be undertaken. However, presentation with symmetric, generalized chorea does not exclude reversible causes, and investigations should address these in addition to genetic and neurodegenerative etiologies.
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Jeon SJ, Choi SS, Kim HY, Yu IK. Acute Acquired Metabolic Encephalopathy Based on Diffusion MRI. Korean J Radiol 2021; 22:2034-2051. [PMID: 34564957 PMCID: PMC8628163 DOI: 10.3348/kjr.2019.0303] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 11/02/2020] [Accepted: 11/20/2020] [Indexed: 11/22/2022] Open
Abstract
Metabolic encephalopathy is a critical condition that can be challenging to diagnose. Imaging provides early clues to confirm clinical suspicions and plays an important role in the diagnosis, assessment of the response to therapy, and prognosis prediction. Diffusion-weighted imaging is a sensitive technique used to evaluate metabolic encephalopathy at an early stage. Metabolic encephalopathies often involve the deep regions of the gray matter because they have high energy requirements and are susceptible to metabolic disturbances. Understanding the imaging patterns of various metabolic encephalopathies can help narrow the differential diagnosis and improve the prognosis of patients by initiating proper treatment regimen early.
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Affiliation(s)
- Se Jeong Jeon
- Department of Radiology, Wonkwang University Hospital, Iksan, Korea
| | - See Sung Choi
- Department of Radiology, Wonkwang University Hospital, Iksan, Korea
| | - Ha Yon Kim
- Department of Radiology, Eulji University Hospital, Deajeon, Korea
| | - In Kyu Yu
- Department of Radiology, Eulji University Hospital, Deajeon, Korea.
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Moon S, Kim HE, Oh TJ, Ahn CH, Choi SH, Jang HC. Hyperglycaemic hemichorea: A case series. Ann Geriatr Med Res 2021; 25:222-225. [PMID: 34192838 PMCID: PMC8497942 DOI: 10.4235/agmr.21.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/29/2021] [Indexed: 11/15/2022] Open
Abstract
Hemichorea has been reported in subjects with hyperglycemia and the recurrent was rarely reported. We identified clinical presentation and course of hypeglycemic hemichorea in six cases, one of whom experienced recurrence. Mean age was 77.2 years and five were women. Duration of diabetes was 1-35 years. Initial HbA1c levels were 9.3%-13% and most patients had poor compliance. Five patients undertook brain magnetic resonance imaging and high signal intensities of basal ganglia was observed in T1-weighted images. All patients were treated with insulin, and four patients were treated with dopamine-receptor blockers. Mean duration of hemichorea was 69 days. One patient’s hemichorea was recurred after 2 months from the time when the first event was resolved and then finally diagnosed with vasculitis. The prognosis of hyperglycaemic hemichoerea seemed to be good. However, we should consider other cause such as vasculitis when the symptom was recurred after adequate glycaemic control.
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Affiliation(s)
- Seoil Moon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hea Eun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae Jung Oh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine, Seoul National University College of Medicin, Seoul, Korea
| | - Chang Ho Ahn
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine, Seoul National University College of Medicin, Seoul, Korea
| | - Sung Hee Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine, Seoul National University College of Medicin, Seoul, Korea
| | - Hak Chul Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine, Seoul National University College of Medicin, Seoul, Korea
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Dong M, E JY, Zhang L, Teng W, Tian L. Non-ketotic Hyperglycemia Chorea-Ballismus and Intracerebral Hemorrhage: A Case Report and Literature Review. Front Neurosci 2021; 15:690761. [PMID: 34248493 PMCID: PMC8260933 DOI: 10.3389/fnins.2021.690761] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 05/11/2021] [Indexed: 11/13/2022] Open
Abstract
Non-ketotic hyperglycemia chorea-ballismus (NKH-CB) is a rare metabolical syndrome secondary to the hyperglycemic condition, which is characterized by a triad of acute or subacute hemichorea-hemiballismus, hyperglycemic state, and unique abnormalities limited to the striatum on neuroimaging. Several related case studies on this disorder have been reported previously, but NKH-CB had never been associated with intracerebral hemorrhage (ICH). Herein, we report an uncommon case of NKH-CB and ICH that occurred simultaneously in one patient, which provides a challenge for clinicians in making a correct diagnosis. An 88-year-old woman with a long-term history of poor-controlled type 2 diabetes mellitus and hypertension, who presented with a sudden-onset headache, restlessness, severe bilateral choreiform and ballistic movements, elevated levels of glucose and osmolality in the serum, an increased white blood cell count, and two-type hyperdense signs on CT imaging, was finally diagnosed with NKH-CB and ICH. Despite administrated active treatments, the patient's clinical status did not improve and ultimately passed away. This case is reported to remind clinicians to consider the possibility of NKH-CB when patients present sudden-onset choreiform and ballistic movements. It is also the first entity with two-type hyperdense signs on CT imaging simultaneously, which helps us distinguish NKH-CB from ICH more intuitively.
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Affiliation(s)
- Mingming Dong
- Department of Neurology, The Fourth People's Hospital of Shenyang, Shenyang, China.,Department of Neurology, The First Hospital of China Medical University, Shenyang, China
| | - Jian-Yu E
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Liyang Zhang
- Department of Neurology, The Fourth People's Hospital of Shenyang, Shenyang, China
| | - Weiyu Teng
- Department of Neurology, The First Hospital of China Medical University, Shenyang, China
| | - Li Tian
- Department of Geriatrics, Shengjing Hospital of China Medical University, Shenyang, China
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12
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Wang W, Tang X, Feng H, Sun F, Liu L, Rajah GB, Yu F. Clinical manifestation of non-ketotic hyperglycemia chorea: A case report and literature review. Medicine (Baltimore) 2020; 99:e19801. [PMID: 32481362 DOI: 10.1097/md.0000000000019801] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Chorea is considered a special complication of diabetes mellitus. Here we report a case of chorea associated with non-ketotic hyperglycemia (NKH). PATIENT CONCERNS The patient was a 79-year-old Asian woman. She had a history of type 2 diabetes mellitus more than 30 years, but with a poor control of blood sugar. She complained of acute onset of right limb involuntary activities, and being admitted to neurology department. DIAGNOSIS The patient was then diagnosed with NKH chorea. INTERVENTIONS Intravenous infusion of insulin was given to reduce blood glucose. Haloperidol was used to control motor symptoms. OUTCOMES Her symptoms improved quickly after treatment. In the past year, the patient's blood sugar was well controlled and her chorea did not recur. LESSONS If there are sudden abnormal movements in patients, in addition to thinking of chorea, hepatolenticular degeneration and other diseases, we should also pay attention to blood sugar, especially in diabetic patients with poor blood sugar control and negative ketone, we should consider the possibility of NKK chorea. CONCLUSIONS NKH chorea is a special complication of diabetes.
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Affiliation(s)
- Weijing Wang
- Department of Neurology, Beijing Haidian Hospital, Beijing Haidian Section of Peking University Third Hospital, Beijing, P.R. China
| | - Xiaomei Tang
- Department of Neurology, Beijing Haidian Hospital, Beijing Haidian Section of Peking University Third Hospital, Beijing, P.R. China
| | - Hao Feng
- Department of Neurology, Beijing Haidian Hospital, Beijing Haidian Section of Peking University Third Hospital, Beijing, P.R. China
| | - Fenghui Sun
- Department of Neurology, Beijing Haidian Hospital, Beijing Haidian Section of Peking University Third Hospital, Beijing, P.R. China
| | - Lei Liu
- Department of Neurology, Beijing Haidian Hospital, Beijing Haidian Section of Peking University Third Hospital, Beijing, P.R. China
| | - Gary B Rajah
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Fengchun Yu
- Department of Neurology, Beijing Haidian Hospital, Beijing Haidian Section of Peking University Third Hospital, Beijing, P.R. China
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"Diabetic striatopathy": clinical presentations, controversy, pathogenesis, treatments, and outcomes. Sci Rep 2020; 10:1594. [PMID: 32005905 PMCID: PMC6994507 DOI: 10.1038/s41598-020-58555-w] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 01/07/2020] [Indexed: 11/08/2022] Open
Abstract
Diabetic striatopathy (DS) is a rare medical condition with ambiguous nomenclature. We searched PubMed database from 1992 to 2018 for articles describing hyperglycemia associated with chorea/ballism and/or neuroimages of striatal abnormalities. Descriptive analysis was performed on demographic/clinical characteristics, locations of striatal abnormalities on neuroimages, pathology findings, treatment strategies, and outcomes. In total, 176 patients (male:female = 1:1.7) were identified from 72 articles with mean age 67.6 ± 15.9 (range, 8-92). Among them, 96.6% had type 2 DM with 17% being newly diagnosed. Average blood glucose and glycated hemoglobin concentrations were 414 mg/dL and 13.1%, respectively. Most patients (88.1%) presented with hemichorea/hemiballism. Isolated putamen and combined putamen-caudate nucleus involvements were most common on neuroimaging studies with discrepancies between CT and MRI findings in about one-sixth of patients. Unilateral arm-leg combination was the most frequent with bilateral chorea in 9.7% of patients. Chorea and imaging anomalies did not appear concomitantly in one-tenth of patients. Successful treatment rates of chorea with glucose-control-only and additional anti-chorea medications were 25.7% and 76.2%, respectively, with an overall recurrence rate being 18.2%. The most commonly used anti-chorea drug was haloperidol. To date, four out of six pathological studies revealed evidence of hemorrhage as a probable pathogenesis.
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Misra UK, Kalita J, Bhoi SK, Dubey D. Spectrum of hyperosmolar hyperglycaemic state in neurology practice. Indian J Med Res 2018; 146:S1-S7. [PMID: 29578188 PMCID: PMC5890590 DOI: 10.4103/ijmr.ijmr_57_15] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background & objectives: Hyperosmolar hyperglycaemic state (HHS) is a medical emergency, but there is a paucity of studies reporting the spectrum of neurological manifestations of HHS. We, therefore, report the neurological spectrum, triggering factors and outcome of HHS in general neurology practice. Methods: The records of the patients with HHS were extracted from computerized hospital information system and those managed currently were prospectively included. The demographic, clinical manifestations, duration of diabetes and precipitating events such as infection, stress and stroke were noted. Patients with HHS were categorized into seizure, movement disorder and encephalopathy groups. Their electroencephalography, magnetic resonance imaging (MRI) findings and outcome were noted. Results: There were 17 patients with HHS (age range 40 and 75 yr) and seven were females. Seven patients were diabetic for five years, one for four years, one for one year and four were diagnosed after the occurrence of HHS. Four patients had epilepsia partialis continua persisting for 72-360 h, one patient had focal seizures and his MRI revealed T2 hyperintensity in frontal region in one patient and cerebellar vermian hyperintensity in another. All the five patients improved, but two had neurological deficits on discharge. Nine patients had encephalopathy which was precipitated by stroke in six patients, urinary infections in two and meningitis in one. Three females had hemichorea-hemiballismus syndrome, which was triggered by infections. Abnormal movements lasted 5-10 days and responded to correction of hyperosmolarity. Nine out of 17 patients improved completely whereas the remaining eight had partial recovery, these patients had stroke, ventilator-related complications or meningoencephalitis. Interpretation & conclusions: The most common presentation of HHS was encephalopathy (9) followed by seizure (5) and hemichorea-hemiballismus syndrome (3) which responded to the correction of hyperosmolar state.
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Affiliation(s)
- U K Misra
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - J Kalita
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - S K Bhoi
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - D Dubey
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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15
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Kurdi H, Ershaid D, Evans P. A case of hemichorea-hemiballism presenting in association with diabetic ketoacidosis. PRACTICAL DIABETES 2017. [DOI: 10.1002/pdi.2082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hibba Kurdi
- The Royal Gwent Hospital; Newport South Wales UK
| | - Dana Ershaid
- The Royal Gwent Hospital; Newport South Wales UK
| | - Peter Evans
- The Royal Gwent Hospital; Newport South Wales UK
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16
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T2*-based MR imaging of hyperglycemia-induced hemichorea-hemiballism. J Neuroradiol 2017; 44:24-30. [DOI: 10.1016/j.neurad.2016.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/19/2016] [Accepted: 09/26/2016] [Indexed: 11/20/2022]
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17
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Roy U, Das SK, Mukherjee A, Biswas D, Pan K, Biswas A, Panwar A. Irreversible Hemichorea-Hemiballism in a Case of Nonketotic Hyperglycemia Presenting as the Initial Manifestation of Diabetes Mellitus. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2016; 6:393. [PMID: 27679748 PMCID: PMC5019112 DOI: 10.7916/d8qz2b3f] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 07/07/2016] [Indexed: 12/01/2022]
Abstract
Background Hemichorea–hemiballism (HCHB) is a hyperkinetic movement
disorder with features of both chorea and ballism occurring on the same side. Case report We present a case of HCHB due to nonketotic hyperglycemia (NKH) that
was the initial presentation of diabetes and was irreversible clinically even
after 6 months of optimal blood sugar control. Discussion Although HCHB due to hyperglycemia is a potentially reversible condition in the
majority of patients, prolonged uncontrolled hyperglycemia may cause ischemic
insult and persistent symptoms. Hyperglycemia should always be kept in the list of
differentials while dealing with patients who are newly diagnosed with HCHB.
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Affiliation(s)
- Ujjawal Roy
- Bangur Institute of Neurosciences, IPGMER, Kolkata, India
| | | | | | | | - Koushik Pan
- Bangur Institute of Neurosciences, IPGMER, Kolkata, India
| | - Atanu Biswas
- Bangur Institute of Neurosciences, IPGMER, Kolkata, India
| | - Ajay Panwar
- King George's Medical University, Lucknow, India
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18
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Zhang T, Shaw M, Humphries J, Sachdev P, Anstey KJ, Cherbuin N. Higher fasting plasma glucose is associated with striatal and hippocampal shape differences: the 2sweet project. BMJ Open Diabetes Res Care 2016; 4:e000175. [PMID: 27252872 PMCID: PMC4885274 DOI: 10.1136/bmjdrc-2015-000175] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/21/2016] [Accepted: 03/29/2016] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Previous studies have demonstrated associations between higher normal fasting plasma glucose levels (NFG) (<6.1 mmol/L), type 2 diabetes (T2D) and hippocampal atrophy and other cerebral abnormalities. Little is known about the association between plasma glucose and the striatum despite sensorimotor deficits being implicated in T2D. This study aimed to investigate the relationship between plasma glucose levels and striatal and hippocampal morphology using vertex-based shape analysis. DESIGN A population-based, cross-sectional study. SETTING Canberra and Queanbeyan, Australia. PARTICIPANTS 287 cognitively healthy individuals (mean age 63 years, 132 female, 273 Caucasian) with (n=261) or without T2D (n=26), selected from 2551 participants taking part in the Personality & Total Health (PATH) Through Life study by availability of glucose data, MRI scan, and absence of gross brain abnormalities and cognitive impairment. OUTCOME MEASURES Fasting plasma glucose was measured at first assessment, and MRI images were collected 8 years later. Shape differences indicating outward and inward deformation at the hippocampus and the striatum were examined with FMRIB Software Library-Integrated Registration and Segmentation Toolbox (FSL-FIRST) after controlling for sociodemographic and health variables. RESULTS Higher plasma glucose was associated with shape differences indicating inward deformation, particularly at the caudate and putamen, among participants with NFG after controlling for age, sex, body mass index (BMI), hypertension, smoking and depressive symptoms. Those with T2D showed shape differences indicating inward deformation at the right hippocampus and bilateral striatum, but outward deformation at the left hippocampus, compared with participants with NFG. CONCLUSIONS These findings further emphasize the importance of early monitoring and management of plasma glucose levels, even within the normal range, as a risk factor for cerebral atrophy.
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Affiliation(s)
- Tianqi Zhang
- Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Marnie Shaw
- Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Jacob Humphries
- Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Perminder Sachdev
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Kaarin J Anstey
- Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Nicolas Cherbuin
- Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, Australian Capital Territory, Australia
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19
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Aquino JHW, Spitz M, Pereira JS. Hemichorea-Hemiballismus as the First Sign of Type 1b Diabetes During Adolescence and Its Recurrence in the Setting of Infection. J Child Neurol 2015; 30:1362-5. [PMID: 25387546 DOI: 10.1177/0883073814553972] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 09/11/2014] [Indexed: 11/16/2022]
Abstract
Chorea may be secondary to hyperosmolar nonketotic hyperglycemia, but such situation has rarely been described in adolescents, particularly as the initial and single manifestation of type 1 diabetes. We describe a case of a previously healthy 14-year-old girl with sudden onset of choreic movements on her left upper and lower limbs. Brain computed tomography (CT) and magnetic resonance imaging (MRI) revealed an area of hyperdensity/hyperintensity affecting the right striatum. Blood glucose was 349 mg/dL. Despite adequate glucose control, the involuntary movements persisted and haloperidol, later substituted with valproate, was prescribed, with satisfactory but not complete resolution of the chorea. In 2 other occasions, when the patient had an infection and subsequent hyperglycemia, the chorea relapsed. Although not common, hyperglycemia must be considered in the differential diagnosis of acute hemichorea-hemiballismus in children and adolescents, particularly because it is a potentially reversible cause.
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Affiliation(s)
| | - Mariana Spitz
- Movement Disorders Section, Neurology Service, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - João Santos Pereira
- Movement Disorders Section, Neurology Service, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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20
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Ray S, Howlader S, Chakraborty S, Chakraborty PP, Ghosh S. Hemichorea-hemiballism as the first presentation of type 2 diabetes. Clin Diabetes 2015; 33:87-9. [PMID: 25897191 PMCID: PMC4398017 DOI: 10.2337/diaclin.33.2.87] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Sukharanjan Howlader
- Department of Radiology, Institute of Post Graduate Medical Education & Research and SSKM Hospital, Kolkata, West Bengal, India
| | - Sumit Chakraborty
- Department of Radiology, Institute of Post Graduate Medical Education & Research and SSKM Hospital, Kolkata, West Bengal, India
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21
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Abstract
Acute encephalopathies arise as a result of various contributions from infections or toxic, metabolic, and/or structural cerebral derangements. With the variety of clinical presentations, neurologic examination, electroencephalography (EEG), and imaging may not identify specific etiologies, but in combination, they can offer guidance regarding underlying causes. Among several different neuroimaging techniques, cerebral computed tomography and brain magnetic resonance imaging are most frequently used for diagnosis, treatment monitoring, and prognostication in acute brain dysfunction. This review compiles the most common and typical features of head computed tomography and magnetic resonance imaging and presents the clinical and EEG associations in adult patients with different types of acute encephalopathy.
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22
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Atay M, Yetis H, Kurtcan S, Aralasmak A, Alkan A. Susceptibility weighted imaging features of nonketotic hyperglycemia: unusual cause of hemichorea-hemiballismus. J Neuroimaging 2014; 25:319-324. [PMID: 24612187 DOI: 10.1111/jon.12084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 08/07/2013] [Accepted: 08/11/2013] [Indexed: 11/30/2022] Open
Abstract
Nonketotic hyperglycemia has been described as a metabolic cause of Hemiballism-hemichorea (HB-HC), especially in elderly patients with poorly controlled diabetes. Pathophysiology is not known yet. MRI features tend to be hyperintense in the putamen on T1-weighted images. We present conventional MRI with diffusion weighted imaging (DWI) and susceptibility weighted imaging (SWI) features of two cases with nonketotic hyperglycemia. T1 hyperintensity without diffusion restriction on DWI and minimal putaminal hypointensity without phase shift on SWI were compatible with either pathological mineralization or petechial microhemorrhage or protein denaturation. In the type 2 diabetic patients with HC-HB, conventional MRI together with SWI and DWI will guide to clinician to plan treatment approach.
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Affiliation(s)
- Musa Atay
- Department of Radiology, Bezmialem Vakif University, İstanbul, Turkey
| | - Huseyin Yetis
- Department of Radiology, Bezmialem Vakif University, İstanbul, Turkey
| | - Serpil Kurtcan
- Department of Radiology, Bezmialem Vakif University, İstanbul, Turkey
| | - Ayse Aralasmak
- Department of Radiology, Bezmialem Vakif University, İstanbul, Turkey
| | - Alpay Alkan
- Department of Radiology, Bezmialem Vakif University, İstanbul, Turkey
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23
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Hansford BG, Albert D, Yang E. Classic neuroimaging findings of nonketotic hyperglycemia on computed tomography and magnetic resonance imaging with absence of typical movement disorder symptoms (hemichorea-hemiballism). J Radiol Case Rep 2014; 7:1-9. [PMID: 24421947 DOI: 10.3941/jrcr.v7i8.1470] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
While there are broad differential diagnoses for either the clinical finding of hemichorea-hemiballism or the imaging finding of lateralizing/asymmetric basal ganglia lesions (hyperdense on computed tomography, hyperintense on T1 magnetic resonance imaging), the presence of both findings is highly suggestive of nonketotic hyperglycemia. We present an unusual case of a patient with vague stroke-like complaints and imaging findings notable for lateralizing basal ganglia lesions. Laboratory analysis revealed nonketotic hyperglycemia and neurologic exam failed to elicit any findings of movement disorder. As far as we know, this is the first published case of a patient with typical neuroimaging manifestations of nonketotic hyperglycemia without associated hemichorea-hemiballism (a disorder of abnormal movements comprised of more proximal, higher amplitude movements-ballismus and lower amplitude, more distal movements-chorea). This finding suggests that radiologists should be alert to the possibility of nonketotic hyperglycemia in patients with asymmetric/lateralizing basal ganglia lesions even in the absence of a movement disorder.
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Affiliation(s)
- Barry G Hansford
- Department of Radiology, University of Chicago Medicine, Chicago, USA
| | - Dara Albert
- Department of Neurology, University of Chicago Medicine, Chicago, USA
| | - Edward Yang
- Department of Radiology, University of Chicago Medicine, Chicago, USA
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24
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Chao CT. Reversible hyperglycemic encephalopathy in a hemodialysis patient. Hemodial Int 2013; 18:562-3. [PMID: 24261414 DOI: 10.1111/hdi.12114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Chia-Ter Chao
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan.
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25
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McCollum D, Silvers S, Dawson SB, Barrett KM. Resolution of acute onset hemichorea-hemiballismus after treatment with intravenous tissue plasminogen activator. Neurohospitalist 2013; 3:131-4. [PMID: 24167646 DOI: 10.1177/1941874412464055] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hyperkinetic movement disorders are uncommon after acute ischemic stroke. Since these movement disorders are rarely the initial manifestation of acute cerebral ischemia, their presence may result in diagnostic uncertainty or it may inappropriately delay intravenous thrombolytic therapy for ischemic stroke. Hemichorea-hemiballism (HC-HB) is one of the more frequently encountered hyperkinetic movement disorders occurring in conjunction with stroke. Although HC-HB may result from a stroke mimic, the acute onset should prompt rapid evaluation and consideration for the presence of stroke along with its time-dependent therapies including recombinant tissue plasminogen activator (rtPA). In this article, we describe a case of a patient with acute cerebral ischemia presenting clinically with HC-HB, who was given intravenous rtPA therapy despite an initially negative, early diffusion-weighted magnetic resonance imaging (MRI). Follow-up brain MRI performed 24 hours after the initiation of thrombolytic therapy confirmed acute infarction in the contralateral striatum. The patient had near-complete resolution of her HC-HB on discharge and had no complications related to the administration of intravenous rtPA.
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Affiliation(s)
- D McCollum
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
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26
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Jalota L, Luber S, Shrestha R, Patel A. Haemorrhagic stroke or hyperglycaemia? BMJ Case Rep 2013; 2013:bcr-2013-010510. [PMID: 23880570 DOI: 10.1136/bcr-2013-010510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 56-year-old woman with no medical history was admitted with acute onset hemiballistic-choreiform movements of right extremity. On admission, her serum glucose and osmolality were elevated. Her glycosylated haemoblobin (HbA1c) was 17.9 with average blood sugars of 467 mg/dL. A CT scan of the brain revealed unilateral hyperintensities in the basal ganglia. A complete stroke work-up, including MRI and MR angiography of brain was otherwise unrevealing. Subcutaneous insulin was instituted, which led to complete resolution of her symptoms within 48 h of hospital admission. She was readmitted 4 weeks after her initial discharge for similar, but less severe, symptoms. This time her HbA1c was 13.9 with an average blood sugar of 352 mg/dL. A repeat MRI demonstrated a persistent abnormal signal within the left basal ganglia without infarct. She was started on subcutaneous insulin. Her symptoms improved but did not resolve. Haloperidol and gabapentin were initiated and she was again discharged after stabilisation to a rehabilitation centre as per physiotherapy recommendations.
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Affiliation(s)
- Leena Jalota
- Department of Internal Medicine, Reading Health System, West Reading, Pennsylvania, PA, USA.
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27
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MRI and CT appearances in metabolic encephalopathies due to systemic diseases in adults. Clin Radiol 2013; 68:545-54. [DOI: 10.1016/j.crad.2012.05.021] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Revised: 05/13/2012] [Accepted: 05/22/2012] [Indexed: 11/17/2022]
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28
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Alves C, Sampaio S, Barbosa V, Machado M. Acute chorea and type 1 diabetes mellitus: clinical and neuroimaging findings. Pediatr Diabetes 2012; 13:e30-4. [PMID: 22369150 DOI: 10.1111/j.1399-5448.2012.00856.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Accepted: 01/13/2012] [Indexed: 11/27/2022] Open
Abstract
The association of type 1 diabetes mellitus (T1DM) and acute chorea is rare. We report an 8-yr-old boy with T1DM who developed acute hemichorea-hemiballism of the right arm in whom magnetic resonance imaging (MRI) of the brain revealed hyperintense signal in putamen and considerable atrophy and focal area of gliosis in the right putamen. There was a deposition of deoxyhemoglobin indicating recent bleeding in the left lentiform nucleus. A control MRI 2 months later showed complete reabsorption of the blood component in the left lentiform nucleus. Multislice computerized tomography revealed hyperdensities in the corpus striatum and subcortical calcifications. This report describes, for the first time, findings of calcifications in the corticomedullary junction in the brain hemispheres of a child with T1DM and chorea and reviews the possible causal mechanisms of this unusual association.
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Affiliation(s)
- Cresio Alves
- Pediatric Endocrinology Unit, Hospital Universitario Prof. Edgard Santos, Faculty of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil.
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29
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Qi X, Yan YY, Gao Y, Zheng ZS, Chang Y. Hemichorea associated with non-ketotic hyperglycaemia: a case report. Diabetes Res Clin Pract 2012; 95:e1-3. [PMID: 21995866 DOI: 10.1016/j.diabres.2011.09.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Accepted: 09/20/2011] [Indexed: 11/20/2022]
Abstract
Hemichorea is a rare complication of non-ketotic hyperglycaemia. Patients with this syndrome have classically longstanding, poorly controlled diabetes. Here, we report a patient presenting hemichorea without diabetic history. His symptom resolved rapidly after correction of hyperglycaemia. We suggest that hemichorea may be the first manifestation of undiagnosed diabetes.
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Affiliation(s)
- Xin Qi
- The 1st Hospital of Jilin University, Xinmin Street 71, Changchun 130021 Jilin, China.
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30
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Movement disorders in patients with diabetes mellitus. J Neurol Sci 2011; 314:5-11. [PMID: 22133478 DOI: 10.1016/j.jns.2011.10.033] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 10/27/2011] [Accepted: 10/28/2011] [Indexed: 11/20/2022]
Abstract
Movement disorders are not infrequent in patients with diabetes mellitus. These may occur on the basis of both central and peripheral nervous system dysfunction and can be secondary to severe hyperglycemia, complications of diabetes or its treatment and less often to diseases in which both diabetes and a movement disorder are primary manifestations of the same underlying disease. We present a typical case of a severe movement disorder complicating diabetes as a springboard to review the spectrum of disorders associated with this condition.
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31
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Stereotypies as a manifestation of acute hyperglycemia without ketosis. J Neurol Sci 2011; 315:176-7. [PMID: 22123156 DOI: 10.1016/j.jns.2011.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 11/04/2011] [Indexed: 11/22/2022]
Abstract
Acute hyperglycemia without ketosis is recognized to induce movement disorders characterized by hemichorea, hemiballismus, or hemidystonia. A video-case of hyperkinetic movement disorder resembling stereotypies in the context of uncompensated hyperglycemia without ketosis is presented, expanding the clinical phenotype of this disorder.
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32
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An unusual cause of hemichorea-hemiballism in a patient with systemic lupus erythematosus. Rheumatol Int 2011; 33:267-8. [PMID: 22083620 DOI: 10.1007/s00296-011-2253-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Accepted: 10/22/2011] [Indexed: 10/15/2022]
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33
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Imaging features of acquired pediatric metabolic and toxic white matter disorders. Top Magn Reson Imaging 2011; 22:239-50. [PMID: 24562093 DOI: 10.1097/rmr.0b013e318296811e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Acquired white matter abnormalities in children may be due to a broad spectrum of disorders, with the most significant related to metabolic and toxic etiologies. Recognition of the imaging appearance of neonatal hypoglycemia, nonketotic hyperglycemia, hyperammonemia, hepatic encephalopathy, and central pontine myelinolysis (CPM) is essential because prompt correction of the underlying metabolic abnormality may limit and, in some cases, reverse the cerebral damage. Toxic leukoencephalopathies encompass disorders caused by iatrogenic administration of pharmacologic agents and radiation therapy, poisoning by household substances, and recreational drug use. Although medication-induced leukoencephalopathies often show a propensity for reversibility of clinical and radiologic findings upon discontinuation of the offending substance, recreational drugs may cause white matter toxicity that often portends a poorer prognosis. Our discussion focuses on the clinical aspects, pathophysiological mechanisms, and imaging features of commonly encountered acquired metabolic and toxic leukoencephalopathies in the pediatric population.
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34
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Hegde AN, Mohan S, Lath N, Lim CCT. Differential diagnosis for bilateral abnormalities of the basal ganglia and thalamus. Radiographics 2011; 31:5-30. [PMID: 21257930 DOI: 10.1148/rg.311105041] [Citation(s) in RCA: 199] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The basal ganglia and thalamus are paired deep gray matter structures that may be involved by a wide variety of disease entities. The basal ganglia are highly metabolically active and are symmetrically affected in toxic poisoning, metabolic abnormalities, and neurodegeneration with brain iron accumulation. Both the basal ganglia and thalamus may be affected by other systemic or metabolic disease, degenerative disease, and vascular conditions. Focal flavivirus infections, toxoplasmosis, and primary central nervous system lymphoma may also involve both deep gray matter structures. The thalamus is more typically affected alone by focal conditions than by systemic disease. Radiologists may detect bilateral abnormalities of the basal ganglia and thalamus in different acute and chronic clinical situations, and although magnetic resonance (MR) imaging is the modality of choice for evaluation, the correct diagnosis can be made only by taking all relevant clinical and laboratory information into account. The neuroimaging diagnosis is influenced not only by detection of specific MR imaging features such as restricted diffusion and the presence of hemorrhage, but also by detection of abnormalities involving other parts of the brain, especially the cerebral cortex, brainstem, and white matter. Judicious use of confirmatory neuroimaging investigations, especially diffusion-weighted imaging, MR angiography, MR venography, and MR spectroscopy during the same examination, may help improve characterization of these abnormalities and help narrow the differential diagnosis.
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Affiliation(s)
- Amogh N Hegde
- Department of Neuroradiology, National Neuroscience Institute, Singapore.
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Kim YH, Kim JY, Seok HY, Koh SB. Hemichorea-hemiballism with a diabetic patient. J Mov Disord 2010; 3:20-1. [PMID: 24868375 PMCID: PMC4027654 DOI: 10.14802/jmd.10006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 04/21/2010] [Indexed: 11/24/2022] Open
Abstract
Chorea and ballism are movement disorders that result from a variety of conditions. They are an uncommon manifestation of diabetes mellitus. We report a 52-year-old diabetic man who presented with acute onset chorea-ballism with a putaminal high-signal-intensity lesion on T1-weighted magnetic resonance imaging (MRI).
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Affiliation(s)
- Yoo Hwan Kim
- Department of Neurology, Korea University, College of Medicine, Guro Hospital, Seoul, Korea
| | - Ju Yeon Kim
- Department of Neurology, Korea University, College of Medicine, Guro Hospital, Seoul, Korea
| | - Hung Youl Seok
- Department of Neurology, Korea University, College of Medicine, Guro Hospital, Seoul, Korea
| | - Seong-Beom Koh
- Department of Neurology, Korea University, College of Medicine, Guro Hospital, Seoul, Korea
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Chang KH, Tsou JC, Chen ST, Ro LS, Lyu RK, Chang HS, Hsu WC, Chen CM, Wu YR, Chen CJ. Temporal features of magnetic resonance imaging and spectroscopy in non-ketotic hyperglycemic chorea-ballism patients. Eur J Neurol 2009; 17:589-93. [PMID: 20039938 DOI: 10.1111/j.1468-1331.2009.02867.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- K-H Chang
- Department of Neurology, Chang Gung Memorial Hospital and University College of Medicine, Taipei, Taiwan
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37
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Sung YH, Park KH, Lee YB, Park HM, Shin DJ. Chorea in the both lower limbs associated with nonketotic hyperglycemia. J Mov Disord 2009; 2:98-100. [PMID: 24868369 PMCID: PMC4027719 DOI: 10.14802/jmd.09027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 10/14/2009] [Accepted: 10/30/2009] [Indexed: 11/27/2022] Open
Abstract
Hemichorea-hemiballism (HC-HB) is a complication of non-ketotic hyperglycemia (NKH); in NKH patients, the frequency of occurrence of HC-HB is greater than that of bilateral chorea. We report the case of a hyperglycemic patient who showed chorea in both the lower limbs. Magnetic resonance imaging (MRI) of the brain revealed high signal intensity on T1-weighted images of the bilateral dorsolateral putamen. The abnormal involuntary movements disappeared after oral administration of haloperidol. Our case report that chorea associated with NKH is correlated with the topography of the basal ganglia.
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Affiliation(s)
- Young-Hee Sung
- Department of Neurology, Gachon University of Medicine and Science, Incheon, Korea
| | - Ki-Hyung Park
- Department of Neurology, Gachon University of Medicine and Science, Incheon, Korea
| | - Yeung-Bae Lee
- Department of Neurology, Gachon University of Medicine and Science, Incheon, Korea
| | - Hyeon-Mi Park
- Department of Neurology, Gachon University of Medicine and Science, Incheon, Korea
| | - Dong-Jin Shin
- Department of Neurology, Gachon University of Medicine and Science, Incheon, Korea
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38
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Malaty IA, Lansang MC, Okun MS. NEUROENDOCRINOLOGIC CONSIDERATIONS IN PARKINSON DISEASE AND OTHER MOVEMENT DISORDERS. Continuum (Minneap Minn) 2009. [DOI: 10.1212/01.con.0000300028.61027.6f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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39
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Battisti C, Forte F, Rubenni E, Dotti MT, Bartali A, Gennari P, Federico A, Cerase A. Two cases of hemichorea-hemiballism with nonketotic hyperglycemia: a new point of view. Neurol Sci 2009; 30:179-83. [DOI: 10.1007/s10072-009-0039-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Accepted: 02/09/2009] [Indexed: 11/29/2022]
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Cherian A, Thomas B, Baheti NN, Chemmanam T, Kesavadas C. Concepts and controversies in nonketotic hyperglycemia-induced hemichorea: Further evidence from susceptibility-weighted MR imaging. J Magn Reson Imaging 2009; 29:699-703. [DOI: 10.1002/jmri.21672] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Erer S, Yilmazlar S, Zarifoglu M, Guclu M. A case report on pituitary macroadenoma presented as hemichorea hemiballism syndrome. Neurol Sci 2008; 29:289-90. [PMID: 18810608 DOI: 10.1007/s10072-008-0984-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ogawa K, Suzuki Y, Kamei S, Mizutani T. [Choreic involuntary movement that occurred during therapy for diabetes mellitus]. Nihon Ronen Igakkai Zasshi 2008; 45:225-30. [PMID: 18441498 DOI: 10.3143/geriatrics.45.225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 73-year-old woman was admitted with dry mouth, polyposia, polyuria, hyperglycemia (611 mg/dl) and positive urine ketone bodies. Blood glucose levels decreased gradually after initiation of insulin injections. The patient was discharged, but developed involuntary movement of the right extremities on the following day. At that time, her blood glucose levels were 54 mg/dl. Four days later, she was admitted to our Neurology Ward because the movement worsened. On admission, choreic involuntary movements were severe in the right extremities and slight in the left extremities. Urine ketone bodies were negative, but HbA1c had elevated to 11.7%. Although a brain CT did not detect any abnormal density areas, we suspected that the patient had cerebral infarction of the basal ganglia or the parietal lobe on the left side, or of the subthalamic nucleus on the right side because choreic involuntary movements were more prominent on the right side. Anti-platelet therapy was performed, but the involuntary movements persisted. A T1-weighted image of brain MRI, performed on the 4th day after hospitalization, detected abnormal high intensity areas in the bilateral putamens. The abnormal area in the left putamen was more prominent. This MRI finding was consistent with that of diabetic chorea-ballism. Surface electromyography demonstrated the simultaneous appearance of grouping discharges in the biceps and triceps muscles of the right arm. We diagnosed the patient as having diabetic chorea based on the MRI findings, and discontinued anti-platelet therapy. MRI should be performed as soon as possible in diabetic patients with acute-onset chorea-ballism which occurs on one side or predominantly on one side in order to differentiate diabetic chorea-ballism from cerebral infarction.
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Affiliation(s)
- Katsuhiko Ogawa
- Division of Neurology, Department of Medicine, Nihon University School of Medicine
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Kim HJ, Moon WJ, Oh J, Lee IK, Kim HY, Han SH. Subthalamic lesion on MR imaging in a patient with nonketotic hyperglycemia-induced hemiballism. AJNR Am J Neuroradiol 2008; 29:526-7. [PMID: 18184834 DOI: 10.3174/ajnr.a0927] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARY Hemiballism with corresponding striatal T1 hyperintensity on MR imaging has occasionally been reported in patients with nonketotic hyperglycemia. However, the subthalamic nucleus lesion, which is believed to be pathogenetically related to hemiballism, is rarely documented in a living patient with nonketotic hyperglycemia. We describe a patient with nonketotic hyperglycemia-induced hemiballism, whose responsible lesion (ie, the subthalamus) was demonstrated by MR imaging.
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Affiliation(s)
- H-J Kim
- Department of Neurology, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, Korea
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Acute bilateral basal ganglia lesions in diabetic uraemia: diffusion-weighted MRI. Neuroradiology 2007; 49:1009-13. [DOI: 10.1007/s00234-007-0299-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Accepted: 07/23/2007] [Indexed: 10/22/2022]
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da Silva CJ, da Rocha AJ, Jeronymo S, Mendes MF, Milani FT, Maia ACM, Braga FT, Sens YAS, Miorin LA. A preliminary study revealing a new association in patients undergoing maintenance hemodialysis: manganism symptoms and T1 hyperintense changes in the basal ganglia. AJNR Am J Neuroradiol 2007; 28:1474-9. [PMID: 17846194 PMCID: PMC8134392 DOI: 10.3174/ajnr.a0600] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Patients undergoing parenteral nutrition and those with portosystemic encephalopathy secondary to chronic liver disease and acquired and congenital portosystemic venous shunts frequently present manganese deposition in the basal ganglia, detected by MR imaging as hyperintense areas on T1-weighted sequences. We also observed similar abnormalities in the basal ganglia of patients with chronic renal failure undergoing maintenance hemodialysis. Our aim was to evaluate the pallidal signal intensity on T1-weighted images in a series of patients undergoing hemodialysis, with further evaluation of serum manganese levels and neurologic correlation, comparing them with patients with chronic renal failure without dialytic treatment. MATERIALS AND METHODS We performed MR imaging examinations in 9 patients with chronic renal failure, 5 of whom were undergoing hemodialysis. An experienced neuroradiologist scrutinized the presence of symmetric hyperintensities in the basal ganglia on T1-weighted sequences. We also determined the serum manganese levels and performed the neurologic evaluations in all patients. RESULTS All patients undergoing hemodialysis presented elevated serum manganese levels and symmetric hyperintensities within the globus pallidus. In this group, 4 patients presented with parkinsonian symptoms, myoclonus, and syndromes with vestibular and vestibular-auditory symptoms. The patients without dialytic treatment presented with neither bilaterally increased T1 MR imaging signal intensity within the globus pallidus nor symptoms of manganism. CONCLUSION Our preliminary results demonstrated the occurrence of bilateral pallidal hyperintensity on T1-weighted images in all patients undergoing hemodialysis associated with high serum manganese levels, revealing a new association.
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Affiliation(s)
- C J da Silva
- Section of Radiology, Laboratório Fleury-Centro de Medicina Diagnóstica, São Paulo-SP, Brazil.
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Nguyen BD. Brain and Upper Extremity PET/CT Findings of Hyperglycemia-Induced Hemiballism-Hemichorea. Clin Nucl Med 2007; 32:643-5. [PMID: 17667442 DOI: 10.1097/rlu.0b013e3180a1acb0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Hyperglycemia-induced hemiballism-hemichorea is an uncommon movement disorder probably related to vascular insult of the basal ganglia in patients with poorly controlled diabetes. This rare clinical entity has been reported with abnormal brain findings on CT, MR, and F-18 FDG PET. The author presents additional PET/CT features of such an unusual dyskinetic syndrome with increased radiotracer uptake in the left motor cortex and musculature of the right shoulder girdle and upper extremity from hemiballism-hemichorea.
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Affiliation(s)
- Ba D Nguyen
- Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Arizona 85259, USA.
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Chang CV, Felicio AC, Godeiro CDO, Matsubara LS, Duarte DR, Ferraz HB, Okoshi MP. Chorea-Ballism as a Manifestation of Decompensated Type 2 Diabetes Mellitus. Am J Med Sci 2007; 333:175-7. [PMID: 17496737 DOI: 10.1097/maj.0b013e3180318e34] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Chorea and ballism are movement disorders that result from a variety of conditions. Hyperglycemia is an unusual recognized cause of these movement disorders. We report 3 cases of new-onset chorea-ballism induced by nonketotic hyperglycemia in elderly patients, highlighting that chorea may be the first manifestation of undiagnosed decompensated diabetes mellitus.
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Affiliation(s)
- Claudia Veiga Chang
- Department of Medicine, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, UNESP, Botucatu, Brazil
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Nath J, Jambhekar K, Rao C, Armitano E. Radiological and pathological changes in hemiballism-hemichorea with striatal hyperintensity. J Magn Reson Imaging 2006; 23:564-8. [PMID: 16514597 DOI: 10.1002/jmri.20548] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We report CT and MRI findings in a 50-year-old African-American woman with hemichorea-hemiballism (HCHB) and hyperglycemia with striatal hyperintensity. Histopathologic findings following autopsy are also described, and possible explanations for the MR findings of this unique syndrome are presented.
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Affiliation(s)
- Jaya Nath
- Department of Radiology, Health Science Center at Brooklyn, State University of New York, Brooklyn, New York 11203, USA.
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Ohmori H, Hirashima K, Ishihara D, Maeda Y, Hirano T, Uyama E, Uchino M. Two cases of hemiballism-hemichorea with T1-weighted MR image hyperintensities. Intern Med 2005; 44:1280-5. [PMID: 16415550 DOI: 10.2169/internalmedicine.44.1280] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Two cases of hemiballism-hemichorea have been reported in woman patients with hyperglycemia; this was a feature of striatal hyperintensity on the T1-weighted MRI. In the first case, strict management of diabetes and treatment with pimozide effectively suppressed the movement disorder. The Z-score Imaging System revealed hyperperfusion in the bilateral dentate nuclei, left striatum, and bilateral motor cortices. In the second case, painful hemiballism-hemichorea limb, followed by the upper limb. The severity of HB-HC corresponded to the expansion of the striatal lesion. The mechanism of HB-HC by using statistical cerebral blood flow evaluation has also been discussed.
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Affiliation(s)
- Hiroyuki Ohmori
- Department of Neurology, Graduate School of Medical Science, Kumamoto University, and the Department of Neurology, Yamaga Chuo Hospital, Japan
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