18F-fluorodeoxyglucose positron emission tomography/computed tomography in a case of non-ketotic hyperglycemia

D’Souza, Maria; Sharma, Rajnish; Jaimini, Abhinav; Mondal, Anupam; Tripathi, Renu

doi:10.4103/0972-3919.142633

Cited by 6 publications

(5 citation statements)

References 14 publications

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“…In the present case, a decrease in the NAA/Cr ratio was observed at the time of initial admission, and an increase in the Cho/Cr ratio was observed at the time of recurrence. Hypoperfusion in the basal ganglia, contralateral to the involuntary movements, is typical on SPECT [ 17 , 18 ] and was also observed in our patient. Although decreased gamma-aminobutyric acid (GABA) levels and perfusion in the basal ganglia have been reported as factors in the pathogenesis of diabetic striatopathy [ 1 ], the MRS and SPECT findings of this case suggest that neuronal loss and dysfunction, gliosis, and ischemia in the putamen are associated with the pathophysiology of diabetic striatopathy.…”

Section: Discussionsupporting

confidence: 80%

Characterization of Diabetic Striatopathy With Repeated Follow-Up Using Multiple Imaging Studies

Nishimura,

Kado,

Tobe

2024

Cureus

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Diabetic striatopathy is a rare condition with a prevalence of less than one in 100,000. Herein, we report a case of diabetic striatopathy exacerbated by hyperglycemia and hypoglycemia, with repeated follow-up with multiple imaging studies. This case suggested that putamen neuronal loss and dysfunction, gliosis, and ischemia are associated with diabetic striatopathy pathophysiology. In addition, striatal hyperintensity on T1-weighted MRI images was more pronounced after symptom remission when evaluated several times over a short period. Therefore, clinicians should be aware that even if MRI findings are normal in the very early stages of the onset of diabetic striatopathy, repeating MRIs at intervals may reveal typical findings.

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Section: Discussionsupporting

confidence: 80%

Characterization of Diabetic Striatopathy With Repeated Follow-Up Using Multiple Imaging Studies

Nishimura,

Kado,

Tobe

2024

Cureus

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“…Many variations of this presentation have been described, including bilateral MRI changes [ 15 16 17 18 19 20 21 22 23 24 ], ipsilateral MRI changes [ 25 ], bilateral chorea [ 23 26 ], recurrent chorea [ 27 28 ] and persistent chorea [ 25 29 30 ]. Cases have been described in the pediatric population [ 31 32 33 34 35 36 ] as well as in both children and adults presenting with ketotic hyperglycemia [ 22 37 38 39 ].…”

Section: Resultsmentioning

confidence: 99%

“…Nine sources examined patients with [ 18 F]-fluorodeoxyglucose (FDG) positron emission tomography (PET) scans. Seven of these demonstrated decreased glucose metabolism of the contralateral basal ganglia, often corresponding with the region of T1 hyperintensity on MRI [ 17 28 42 44 45 46 47 ]. One case series imaged two patients at different time points; at nine days after symptom onset there was a contralateral increase in glucose metabolism, while at fifty-five days after onset there was a relative decrease [ 39 ].…”

Section: Resultsmentioning

confidence: 99%

One Side of the Story; Clues to Etiology in Patients with Asymmetric Chorea

Cincotta¹,

Walker

2022

Tremor and Other Hyperkinetic Movements

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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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“…FLAIR sequencing showed a dominance of equal or low signal and a minority of mixed high-and-low signal, and enhanced scan reported no enhancement (13,22). Single photon emission computed tomography (SPECT) showed a significant decrease in blood perfusion at the corresponding lesions (23). After 3 months of treatment, we found a lighter and narrowed signal intensity in the left lentiform nucleus on T1weighted images on April 18, 2019 ( Figure 4D).…”

Section: Imaging Features Of Hc-nhmentioning

confidence: 95%

Hemichorea Associated With Non-ketotic Hyperglycemia: A Case Report and Literature Review

Zheng

Chen

et al. 2020

Front. Neurol.

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Objective: To explore the clinical manifestation, diagnosis, therapy, and mechanism of hemichorea associated with non-ketotic hyperglycemia (HC-NH) so as to enhance awareness and avoid misdiagnosis or missed diagnosis of the disease. Methods: A case of HC-NH was reported and reviewed in terms of the clinical features, diagnosis and treatment. Results: Hemichorea associated with non-ketotic hyperglycemia is a rare complication of diabetes mellitus, which is commonly seen in elderly women with poorly-controlled diabetes. The condition is characterized by non-ketotic hyperglycemia, unilateral involuntary choreiform movements, and contralateral basal ganglia hyper-intensity by T1-weighted MR imaging or high density on CT scans. Blood glucose control is the basal treatment, in combination with dopamine receptor antagonists and benzodiazepine sedative, in controlling hemichorea. Conclusion: In clinical practice, the possibility of unilateral chorea should be considered for diabetic patients with poor blood glucose control.

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18F-fluorodeoxyglucose positron emission tomography/computed tomography in a case of non-ketotic hyperglycemia

Cited by 6 publications

References 14 publications

Characterization of Diabetic Striatopathy With Repeated Follow-Up Using Multiple Imaging Studies

Characterization of Diabetic Striatopathy With Repeated Follow-Up Using Multiple Imaging Studies

One Side of the Story; Clues to Etiology in Patients with Asymmetric Chorea

Hemichorea Associated With Non-ketotic Hyperglycemia: A Case Report and Literature Review

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