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In vivo proton MR spectroscopy of chorea-ballismus in diabetes mellitus.

Abstract
The most common cause of chorea-ballismus (CB) is a vascular lesion; it is also associated with nonketotic hyperglycaemia in diabetes mellitus (DM) and may be the first manifestation of this disorder. We describe the CT, MRI and proton MR spectroscopy (1H-MRS) of CB in eight patients. Six had hemichorea-hemiballismus (HC-HB) and two bilateral CB. Single-voxel (SV) 1H-MRS was performed using point-resolved spectroscopy (PRESS). Voxels were positioned in the basal ganglia of the patients and control subjects. PRESS was also used to obtain spectroscopic imaging (1H-MRSI) of the slice of interest in two patients. CT showed a slightly dense striatum in all the patients with CB, and T1-weighted images revealed high signal. The CB correlated well with the neuroimaging findings. SV 1H-MRS showed the mean (+/- SD) N-acetylaspartate (NAA)/ creatine (Cr) ratio to be 1.45 +/- 0.19 in HC-HB and 1.82 +/- 0.06 on the opposite normal side (P = 0.01). The choline (Cho)/ Cr ratio was 1.3 +/- 0.12 in HC-HB and 1.11 +/- 0.13 on the opposite normal side (P = 0.005). A lactate peak was seen in seven patients. The NAA/Cr ratio was 1.44 +/- 0.15 in bilateral CB and 1.74 +/- 0.16 in the controls (P = 0.017); the Cho/Cr ratios were 1.36 +/- 0.1 and 1.19 +/- 0.07 (P = 0.015). The low NAA/Cr suggests neuronal loss or damage and the high Cho/Cr probably indicates gliosis. The presence of lactate may suggest mild ischaemia due to acute vascular events during hyperglycaemia and underlying chronic focal cerebrovascular diseases in DM.
AuthorsP H Lai, P C Chen, M H Chang, H B Pan, C F Yang, M T Wu, J Y Li, C Chen, H L Liang, W L Chen
JournalNeuroradiology (Neuroradiology) Vol. 43 Issue 7 Pg. 525-31 (Jul 2001) ISSN: 0028-3940 [Print] Germany
PMID11512579 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Aspartic Acid
  • N-acetylaspartate
  • Creatine
  • Choline
Topics
  • Aged
  • Aspartic Acid (analogs & derivatives, metabolism)
  • Choline (metabolism)
  • Chorea (diagnosis, etiology, metabolism)
  • Creatine (metabolism)
  • Diabetes Complications
  • Female
  • Humans
  • Hyperglycemia (complications)
  • Magnetic Resonance Imaging
  • Magnetic Resonance Spectroscopy
  • Male
  • Middle Aged
  • Tomography, X-Ray Computed

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