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Wettasinghe I, Elanko A, Ratnayake A, Rajendiran VT, Mendis S. A rare neurological manifestation of diabetes mellitus-Hemichorea-hemiballismus in a patient with diabetic striatopathy: A case report. SAGE Open Med Case Rep 2024; 12:2050313X231222203. [PMID: 38187814 PMCID: PMC10768625 DOI: 10.1177/2050313x231222203] [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: 09/11/2023] [Accepted: 11/30/2023] [Indexed: 01/09/2024] Open
Abstract
Diabetic striatopathy is a rare neurological complication of diabetes mellitus that presents with sudden onset hemichorea or hemiballismus and is associated with hyperglycemia and striatal abnormality, either by hyperdensity on non-contrast computer tomography or hyperintensity on T1-weighted magnetic resonance imaging. Here we report a 55-year-old female, from Sri Lanka, who presented with involuntary movements of the left upper and lower limbs. Her past medical history included diabetes mellitus and she was on warfarin 5 mg daily for a mechanical mitral and tricuspid valve replacement. The random blood sugar on admission was 462 mg/dL and the last INR was 3.03. While hemiballismus has multiple etiologies, intracranial hemorrhage would be the main differential in a patient on anticoagulation. Other differentials include drug-induced dyskinesia, metabolic abnormalities, and autoimmune etiologies. Hemiballismus in the presence of high blood glucose should always raise the suspicion of diabetic striatopathy. The non-contrast computed tomography of the brain showed hyperdensity in the right-side caudate nucleus, lentiform nucleus, and globus pallidus which is a characteristic of diabetic striatopathy but could have been mistaken for an intracranial hemorrhage. The involuntary movements improved with glucose control and treatment with clonazepam and tetrabenazine. This case highlights the potential for misdiagnosis of diabetic striatopathy as an intracranial hemorrhage in a patient on warfarin, which can lead to delays in appropriate management and erroneous omission of warfarin. Early recognition and treatment of diabetic striatopathy can lead to significant improvement in the quality of life.
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Affiliation(s)
| | | | | | | | - Suresh Mendis
- Colombo South Teaching Hospital, Kalubowila, Sri Lanka
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2
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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: 6] [Impact Index Per Article: 6.0] [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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3
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The youngest patient with hemi-chorea and diabetic ketoacidosis as presenting manifestation of type 1 diabetes mellitus from India. Int J Diabetes Dev Ctries 2023. [DOI: 10.1007/s13410-023-01171-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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4
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Saroufim R, Hannon T. Nonketotic hyperglycemic hemichorea-hemiballismus in a pediatric patient: A case report. Clin Case Rep 2023; 11:e6857. [PMID: 36698526 PMCID: PMC9851085 DOI: 10.1002/ccr3.6857] [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: 10/04/2022] [Revised: 12/26/2022] [Accepted: 01/03/2023] [Indexed: 01/20/2023] Open
Abstract
Nonketotic hyperglycemic hemichorea-hemiballismus (NHHH) is an infrequent complication of diabetes mellitus, and rarely occurs in children. We present an adolescent boy with recent diagnosis of type 1 diabetes who presented with hemichorea and brain imaging findings consistent with NHHH. His symptoms resolved with euglycemia and valproic acid after few weeks.
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Affiliation(s)
- Rita Saroufim
- Division of Pediatric Endocrinology, Department of Pediatrics, Riley Hospital for Children at IU HealthIndiana University School of MedicineIndianapolisIndianaUSA
| | - Tamara Hannon
- Division of Pediatric Endocrinology, Department of Pediatrics, Riley Hospital for Children at IU HealthIndiana University School of MedicineIndianapolisIndianaUSA
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Marian J, Rizvi F, Lew LQ. Nonketotic Hyperglycemic Chorea in a 10-Year-Old Asian Boy with Diabetes Mellitus. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0040-1718553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractNonketotic hyperglycemic chorea-ballism (NKHCB), also known as diabetic striato-pathy (DS) by some, is a rare complication of diabetes mellitus and uncommon in children. We reported a case of a 10 11/12-year-old male child of Asian descent with uncontrolled type 1 diabetes mellitus (T1DM), Hashimoto's thyroiditis, and multiple food allergies presenting with bilateral chorea-ballism. His brain magnetic resonance imaging revealed developmental venous anomaly in right parietal lobe and right cerebellum, no focal lesions or abnormal enhancements. Choreiform movements resolved with correction of hyperglycemia. Children and adolescents with a movement disorder should be evaluated for diabetes mellitus, especially with increasing prevalence and insidious nature of T2DM associated with obesity.
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Affiliation(s)
- Julia Marian
- Department of Pediatrics, Flushing Hospital Medical Center, Flushing, New York, United States
| | - Firdous Rizvi
- Department of Pediatrics, Flushing Hospital Medical Center, Flushing, New York, United States
| | - Lily Q. Lew
- Department of Pediatrics, Flushing Hospital Medical Center, Flushing, New York, United States
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6
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Iri T, Yano H, Kinjo M. Diabetic striatopathy. BMJ Case Rep 2021; 14:e244248. [PMID: 34376423 PMCID: PMC8382270 DOI: 10.1136/bcr-2021-244248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/03/2022] Open
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Abstract
OBJECTIVE To describe the spectrum of neonatal diabetes mellitus (NDM), document new mutations, and review published Indian literature on the etiology of NDM. METHODS Retrospective analysis of the clinical and genetic profile of 12 NDM patients. RESULTS Eight patients presented with NDM before the age of 6 mo. Three other patients, including 2 siblings presented in later part of infancy. An additional patient was diagnosed at age 5 y with the same etiology as her infant sibling. Four patients had transient diabetes [TNDM:1 each with a mutation in KCNJ11 and INS gene, 2 with ABCC8 mutation], 7 had permanent diabetes [PNDM: 2 siblings with complete glucokinase deficiency, 2 siblings with thiamine responsive megaloblastic anemia (TRMA), 1 with Immune dysregulation, Polyendocrinopathy, Enteropathy, X-linked (IPEX) syndrome and 2 with Wolcott Rallison syndrome, (WRS)]. Four patients had 5 novel mutations. Genetic etiology could not be established in 1 patient with features of insulin resistance. Poorly controlled blood glucose in the TRMA patient led to hyperglycemia-induced hemichorea-hemiballismus, a rare manifestation in children. CONCLUSIONS The authors describe 5 novel mutations, in the EIF2AK3, ABCC8, and GCK genes, a homozygous mutation at the ABCC8 locus presenting as TNDM, an obscure phenotype of the GCK gene mutation, and hyperglycemia-induced hemichorea-hemiballismus in a patient with TRMA. In India, PNDM is most commonly due to WRS similar to Middle Eastern countries with high consanguinity rates.
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8
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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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9
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Garone G, Graziola F, Grasso M, Capuano A. Acute Movement Disorders in Childhood. J Clin Med 2021; 10:jcm10122671. [PMID: 34204464 PMCID: PMC8234395 DOI: 10.3390/jcm10122671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 12/14/2022] Open
Abstract
Acute-onset movement disorders (MDs) are an increasingly recognized neurological emergency in both adults and children. The spectrum of possible causes is wide, and diagnostic work-up is challenging. In their acute presentation, MDs may represent the prominent symptom or an important diagnostic clue in a broader constellation of neurological and extraneurological signs. The diagnostic approach relies on the definition of the overall clinical syndrome and on the recognition of the prominent MD phenomenology. The recognition of the underlying disorder is crucial since many causes are treatable. In this review, we summarize common and uncommon causes of acute-onset movement disorders, focusing on clinical presentation and appropriate diagnostic investigations. Both acquired (immune-mediated, infectious, vascular, toxic, metabolic) and genetic disorders causing acute MDs are reviewed, in order to provide a useful clinician’s guide to this expanding field of pediatric neurology.
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Affiliation(s)
- Giacomo Garone
- Movement Disorders Clinic, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, viale San Paolo 15, 00146 Rome, Italy; (G.G.); (F.G.); (M.G.)
- University Department of Pediatrics, Bambino Gesù Children’s Hospital, 00165 Rome, Italy
| | - Federica Graziola
- Movement Disorders Clinic, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, viale San Paolo 15, 00146 Rome, Italy; (G.G.); (F.G.); (M.G.)
| | - Melissa Grasso
- Movement Disorders Clinic, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, viale San Paolo 15, 00146 Rome, Italy; (G.G.); (F.G.); (M.G.)
| | - Alessandro Capuano
- Movement Disorders Clinic, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, viale San Paolo 15, 00146 Rome, Italy; (G.G.); (F.G.); (M.G.)
- Correspondence:
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10
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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: 91] [Impact Index Per Article: 22.8] [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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11
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Suratos CTR, Benitez JAEL, Urquiza SC, Sacro CAL. Paediatric non-ketotic hyperglycaemic hemichorea-hemiballismus. BMJ Case Rep 2018; 2018:bcr-2017-223429. [PMID: 29622707 DOI: 10.1136/bcr-2017-223429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Non-ketotic hyperglycaemic hemichorea-hemiballismus (NHHH) is commonly seen among elderly Asian women with type 2 diabetes mellitus. Here, we present a case of a 16-year-old Filipina with type 1 diabetes mellitus who is poorly compliant to her medications and subsequently developed right hemichorea-hemiballismus (HH). She was initially admitted with hyperglycaemia but was negative for ketonuria or metabolic acidosis. Neuroimaging showed bilateral lentiform nuclei and left caudate hyperdensities on CT and T1-weighted hyperintensity on MRI. Blood glucose was controlled with insulin. Haloperidol and clonazepam were started for the HH with gradual resolution of symptoms in 6 weeks. This is the fifth reported case of NHHH seen among the paediatric age group. NHHH in the paediatric population is clinically and radiographically similar to NHHH seen among adults. Correction of hyperglycaemia results in clinical improvement and radiographic resolution of lesions but persistent cases may necessitate specific treatment targeted towards the abnormal movements.
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Affiliation(s)
- Cezar Thomas Reyes Suratos
- Department of Neurosciences, University of the Philippines Manila College of Medicine, Manila, Philippines
| | - James Albert Edward Lim Benitez
- Department of Neurosciences, University of the Philippines Manila College of Medicine, Manila, Philippines.,Department of Pediatrics, University of the Philippines Manila College of Medicine, Manila, Philippines
| | - Sheen Corvera Urquiza
- Department of Radiology, University of the Philippines Manila College of Medicine, Manila, Philippines
| | - Cheryl Anne Lubaton Sacro
- Department of Neurosciences, University of the Philippines Manila College of Medicine, Manila, Philippines.,Department of Pediatrics, University of the Philippines Manila College of Medicine, Manila, Philippines
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12
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Abstract
Chorea is a symptom of a broad array of genetic, structural, and metabolic disorders. While chorea can result from systemic illness and damage to diverse brain structures, injury to the basal ganglia, especially the putamen or globus pallidus, appears to be a uniting features of these diverse neuropathologies. The timing of onset, rate of progression, and the associated neurological or systemic symptoms can often narrow the differential diagnosis to a few disorders. Recognizing the correct etiology for childhood chorea is critical, as numerous disorders in this category are potentially curable, or are remediable, with early treatment.
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Affiliation(s)
- Claudio M de Gusmao
- Department of Neurology, Boston Children's Hospital, Boston, MA; Department of Neurology, Brigham and Women's Hospital, Boston, MA
| | - Jeff L Waugh
- Department of Neurology, Boston Children's Hospital, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston, MA.
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13
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Ko TH, Lee HH, Hsieh AT, Hu CJ, Chen CC. Bilateral chorea-ballism and diabetic ketoacidosis as the initial presentation of a case with maternally inherited diabetes and deafness. Acta Diabetol 2017; 54:795-797. [PMID: 28361170 DOI: 10.1007/s00592-017-0982-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 03/09/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Tzu-Hsiang Ko
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan
| | - Hsun-Hua Lee
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan
| | - An-Tsz Hsieh
- Department of Endocrinology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Chaur-Jong Hu
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan
- Department of Neurology, Taipei Medical University, Taipei, Taiwan
| | - Chih-Chung Chen
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan.
- Department of Neurology, Taipei Medical University, Taipei, Taiwan.
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14
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Das L, Pal R, Dutta P, Bhansali A. "Diabetic striatopathy" and ketoacidosis: Report of two cases and review of literature. Diabetes Res Clin Pract 2017; 128:1-5. [PMID: 28431304 DOI: 10.1016/j.diabres.2017.03.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 03/04/2017] [Accepted: 03/13/2017] [Indexed: 12/17/2022]
Abstract
"Diabetic striatopathy" is characterized by dyskinesias with basal ganglia hyperintensities on neuroimaging. It is usually reported in elderly females with hyperglycemic hyperosmolar state and rare in patients with diabetic ketoacidosis. Here, we report two young males with diabetic ketoacidosis presenting as striatopathy, along with review of literature.
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Affiliation(s)
- Liza Das
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rimesh Pal
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Pinaki Dutta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Anil Bhansali
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
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15
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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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16
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Faundez T, Klee P, Hanquinet S, Schwitzgebel V, Burkhard PR, Korff CM. Diabetic Striatopathy in Childhood: A Case Report. Pediatrics 2016; 137:peds.2014-3761. [PMID: 27012747 DOI: 10.1542/peds.2014-3761] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2015] [Indexed: 11/24/2022] Open
Abstract
Diabetic striatopathy is a well-known complication of diabetes in adults. To our knowledge, only 2 cases have been reported in children. We here report the case of a teenager in whom diabetic striatopathy was revealed by the subacute appearance of hemichorea-hemiballism in the context of weight loss, polyuria, and polydipsia. Glycemia control allowed rapid clinical recovery despite established striatal lesions documented on MRI. We also discuss current hypotheses about pathophysiological processes underlying this entity.
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Affiliation(s)
| | - Philippe Klee
- Endocrinology and Diabetes Unit, Department of Child and Adolescent
| | | | | | - Pierre R Burkhard
- Neurology Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Switzerland
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17
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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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18
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Mulder L, Onur O, Kleis L, Borders H, Cemeroglu AP. Atypical neurologic presentations of new onset type 1 diabetes mellitus in pediatric age group: a report of five unusual cases and review of the literature. J Pediatr Endocrinol Metab 2014; 27:749-56. [PMID: 24526607 DOI: 10.1515/jpem-2013-0312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 12/27/2013] [Indexed: 11/15/2022]
Abstract
Type 1 diabetes mellitus (T1DM) is one of the most common chronic diseases in childhood and is caused by insulin deficiency resulting from the autoimmune destruction of insulin producing beta cells of the pancreas. Most children in the US with new onset T1DM present with the classic signs and symptoms of hyperglycemia and 30% with diabetic ketoacidosis (DKA). Neurologic manifestations are relatively rare and mostly include lethargy, decreased level of consciousness, and coma as a result of DKA. In this article, five cases of new onset T1DM with exceedingly rare or unreported neurologic manifestations in the pediatric age group are presented, along with a review of the literature.
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