Chorea-ballismus with nonketotic hyperglycemia in primary diabetes mellitus.

Abstract

PURPOSE:

To describe the neuroimaging (Ct, MR, and single-photon emission CT [SPECT]) findings in a series of patients with chorea-ballismus associated with nonketotic hyperglycemia in primary diabetes mellitus and to correlate the imaging findings with the clinical presentation.

METHODS:

The neuroimaging and clinical data from 10 patients with chorea-ballismus associated with nonketotic hyperglycemia in primary diabetes mellitus were evaluated. Family and drug histories, as well as other causes of chorea, were excluded. All 10 patients had CT, 5 also had MR imaging, and 3 had SPECT examinations. Three had follow-up CT and MR imaging studies, and MR findings were correlated with CT findings in 5 cases. Two experienced neuroradiologists, aware of the diagnosis but blinded to the clinical status of the patients, evaluated all images and reached a consensus as to the final interpretation.

RESULTS:

CT studies in 9 of 10 patients showed a hyperdense putamen and/or caudate nucleus; in 1, the CT findings were normal. T1-weighted MR images in all 5 patients who had MR imaging (including the patient with a normal CT study) showed hyperintense lesions without significant T2 signal alternation at the basal ganglia. In all 3 of the patients who had SPECT studies of the brain, the scans revealed hypoperfusion at corresponding areas. All 3 follow-up studies depicted resolution of the lesions in the abnormal basal ganglia. Increased hypointensity on T2-weighted and gradient-echo T2*-weighted images was also observed in the sequential MR images. In all patients, the initial side of involvement correlated well with the neuroimaging findings. The chorea resolved within 2 days after treatment of the hyperglycemia in 9 patients.

CONCLUSION:

In patients with chorea-ballismus associated with nonketotic hyperglycemia in primary diabetes mellitus, CT and T1-weighted MR images show unilateral or bilateral lesions of the putamen and/or caudate. SPECT scans show hypoperfusion. These findings may be related to petechial hemorrhage and/or myelin destruction. Early recognition of these imaging characteristics may facilitate diagnosis of primary diabetes mellitus with hyperglycemia and prompt appropriate therapy.

• Authors: P H Lai, R D Tien, M H Chang, M M Teng, C F Yang, H B Pan, C Chen, J F Lirng, K W Kong
• Journal: AJNR. American journal of neuroradiology (AJNR Am J Neuroradiol) 1996 Jun-Jul Vol. 17 Issue 6 Pg. 1057-64 ISSN: 0195-6108 [Print] United States
• PMID: 8791916 (Publication Type: Journal Article)

Topics

• Aged
• Basal Ganglia Diseases (diagnosis)
• Brain Diseases, Metabolic (diagnosis)
• Brain Ischemia (diagnosis)
• Caudate Nucleus (pathology)
• Chorea (diagnosis)
• Dominance, Cerebral (physiology)
• Humans
• Hyperglycemic Hyperosmolar Nonketotic Coma (diagnosis)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Neurologic Examination
• Putamen (pathology)
• Retrospective Studies
• Tomography, Emission-Computed, Single-Photon
• Tomography, X-Ray Computed