Cranial Magnetic Resonance Imaging and Angiography Findings in a Patient With Hyperglycemic Hemichorea-Hemiballism

Nagai, Junko; Yamada, Tsutomu; Cao, Xi‐Ren; Fukui, Akifumi; Tajitsu, Machiko; Yamakawa, Fumiko; Yambe, Yuko; Murase, Takashi; Watanabe, Masashi; Shimada, Fumiyuki

doi:10.1210/jc.2014-2576

Cited by 9 publications

(5 citation statements)

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“…This fact illustrates the The pathogenesis of diabetic striatopathy remains unclear, and the present case has important implications. In the present case, magnetic resonance angiography illustrated oozing around the basal ganglia, which is similar to the results of previous reports [22] in which vascular injury was suspected. In the present case, magnetic resonance angiography illustrated oozing around the basal ganglia, which is similar to the results of previous reports [22] in which vascular injury was suspected.…”

Section: What's New?supporting

confidence: 92%

“…To date, possible mechanisms reported include microhaemorrhage [16,17], reactive astrocytes associated with ischaemia [18,19], and metabolic disorder with decreased caminobutyric acid production [20,21]. In the present case, magnetic resonance angiography illustrated oozing around the basal ganglia, which is similar to the results of previous reports [22] in which vascular injury was suspected. Because CT showed faint hyperdense lesions and the onset was rather acute, this magnetic resonance angiography finding might reflect an acute microhaemorrhage.…”

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confidence: 87%

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Diabetic striatopathy manifesting as severe consciousness disturbance with no involuntary movements

et al. 2017

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Section: What's New?supporting

confidence: 92%

supporting

confidence: 87%

Diabetic striatopathy manifesting as severe consciousness disturbance with no involuntary movements

et al. 2017

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“…The uniting theory, therefore, would be that asymmetric microvasculopathy, likely driven by uncontrolled diabetes mellitus and other risk factors, would create vulnerability to metabolic insult in the setting of extreme hyperglycemia. While large vessel ischemic vulnerability seems to be a rare contributing factor, one report noted middle cerebral artery (MCA) stenosis ipsilateral to the MRI lesion [ 43 ]. While it is not possible to know whether this was an incidental finding, this observation would support a unilateral perfusional vulnerability.…”

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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“…by gemistocytes. In two studies, angioMRI disclosed middle cerebral artery stenosis, possibly causing basal ganglia hypoperfusion [ 89 ] or oozing-type findings, supporting microhemorrhage's role in the pathogenesis of DS [ 90 ].…”

Section: Typical Neuroimaging Findings Include Increased Striatal Sig...mentioning

confidence: 99%

Diabetic striatopathy: an updated overview of current knowledge and future perspectives

Arecco

Ottaviani

Boschetti

et al. 2023

J Endocrinol Invest

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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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Cranial Magnetic Resonance Imaging and Angiography Findings in a Patient With Hyperglycemic Hemichorea-Hemiballism

Cited by 9 publications

References 5 publications

Diabetic striatopathy manifesting as severe consciousness disturbance with no involuntary movements

Diabetic striatopathy manifesting as severe consciousness disturbance with no involuntary movements

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

Diabetic striatopathy: an updated overview of current knowledge and future perspectives

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