Diabetic Hemichorea-hemiballism after Prompt Improvement in Hyperglycemia

Kitagawa, Masayuki; Yamanaka, Yoshihiro; Adachi, Tsutomu; Ito, Junitsu; Fukase, Kazutoshi; Ohta, Ikuro; Katagiri, Tadashi

doi:10.2169/internalmedicine.8615-16

Cited by 9 publications

(10 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In diabetic hemichoreahemiballism, striatal hyperintensity is typically seen on T1-weighted magnetic resonance imaging. [4][5][6] These reports support that HCHB is associated with basal ganglia, as demonstrated in our three cases.…”

Section: Discussionsupporting

confidence: 90%

See 1 more Smart Citation

Clinical features of hemichoreahemiballism: A stroke-related movement disorder

et al. 2020

View full text Add to dashboard Cite

We examined pathogenesis and clinical features of three hemichorea-hemiballism (HCHB) cases. We studied their age, magnetic resonance imaging results, vascular risk factors, management, and outcomes. One man and two women (aged 74-86 years) demonstrated acute onset of HCHB, lasting for at least several months. Patients had one or more vascular risk factors, including hypertension and diabetes. All patients presented subacute or old infarction in the basal ganglia with contralateral symptoms. We administered clonazepam (0.5-1 mg/day), haloperidol (0.375-0.75 mg/day), or both as necessary and observed symptom-control. Vascular lesions in the basal ganglia were a contributing factor. Symptoms were controlled using pharmacotherapy with gamma-aminobutyric acid-agonist (clonazepam) or anti-dopaminergic (haloperidol) medication.

show abstract

Section: Discussionsupporting

confidence: 90%

“…Apart from cerebral vascular diseases, HCHB occurs unilaterally due to nonketotic hyperglycemia. [4][5][6] Among the three patients, one had diabetes; however, his blood sugar levels were not high enough to be considered HCHBassociated. Therefore, our cases were considered purely stroke-related.…”

Section: Discussionmentioning

confidence: 99%

Clinical features of hemichoreahemiballism: A stroke-related movement disorder

et al. 2020

View full text Add to dashboard Cite

show abstract

“…This finding explained why an increased hyperintensity on T1 images was observed on the follow-up MRI, although the clinical symptoms have been completely relieved. The delayed resolution of T1 hyperintensity indicated that MRI may be a good tool for evaluating the presence of DS (Lin et al, 2001 ; Kitagawa et al, 2017 ; Zheng et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Diabetic Striatopathy Complicated With Acute Ischemic Stroke: A Case Report

et al. 2022

Front. Neurosci.

View full text Add to dashboard Cite

Diabetic striatopathy (DS) is a rare complication secondary to hyperglycemia, featured by the choreiform movements and reversible striatal abnormalities on neuroimaging. Several studies have described the clinical characteristics of DS, however, the simultaneous occurrence of DS and acute ischemic stroke (AIS) in the striatum has not been reported. Herein, we report a 68-year-old man with uncontrolled type 2 diabetes who experienced the progressive involuntary movement of the right upper and lower limbs for 10 days. We initially considered this patient as an AIS with hemorrhage in the left basal ganglia and adjacent area because his brain magnetic resonance imaging (MRI) showed hyperintensity on fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted imaging (DWI) images, as well as slight T1-hyperintensity around T1-hypointensity. However, his symptoms worsen persistently, which was inconsistent with neuroimaging findings. Further computed tomography (CT) scan revealed an extensive hyper-density and focal low-density in the left striatum, suggesting the diagnosis of DS and AIS. His symptoms were in complete remission after 2 months of glucose control. However, striatal hyperintensity on T1 images was significantly increased compared to the initial images, which disappeared 18 months later. Additionally, DWI hyperintensity on infarction lesions disappeared, while softening lesions and gliosis were observed on the follow-up MRI images. Therefore, we finally diagnosed the patient as DS complicated with AIS. This report highlights that DS and AIS could occur simultaneously in the striatum after hyperglycemia, which is easily misdiagnosed as AIS with hemorrhage and requires clinicians to pay more attention to avoid misdiagnosis and delayed treatment.

show abstract

“…Moreover, the presentation of involuntary movements in DS may vary among patients; they could start abruptly (as described here) or insidiously (from a low to high amplitude) and manifest intermittently or continuously [ 9 ]. Cases with chorea progressing from the upper to lower extremities [ 28 , 31 ] are more common than the opposite [ 32 ]. In addition, chorea typically worsens during physical or mental stress and, unlike our patient, disappears after sleep.…”

Section: Discussionmentioning

confidence: 99%

Diabetic Striatopathy: Parenchymal Transcranial Sonography as a Supplement to Diagnosis at the Emergency Department

Godani¹,

Lanza

2022

Diagnostics

View full text Add to dashboard Cite

Background: Diabetic striatopathy (DS) is a rare condition with a debated pathophysiology; a local metabolic dysfunction is the most likely hypothesis. We present a case of DS mimicking an acute stroke, outline a few uncommon/atypical features, and report for the first time the parenchymal transcranial sonography (pTCS) findings. Case Report: An 86-year-old man, treated for insulin-dependent diabetes, presented at an emergency department because of the occurrence of isolated choreo-athetotic movements in his left limbs with fluctuations in the location, frequency, and duration. The blood glucose level was 569 mg/dL. Both urgent and follow-up brain computed tomography (CT) were negative for recent lesions whereas pTCS revealed hyperechogenicity in the right lenticular nucleus. Subsequent magnetic resonance imaging (MRI) showed T1-weighted hyperintensity in the right putamen with negative diffusion-weighted imaging. The symptoms were responsive to glucose control and haloperidol administration, although they persisted during sleep. Conclusions: Unlike previously described cases characterized by hemichorea and/or hemiballism, our patient presented with a stroke-like onset of unilateral irregular choreo-athetotic movements. Notably, based on CT alone, it would not have been possible to distinguish DS from a stroke. In this scenario, the pTCS hyperechogenicity of the right lenticular nucleus helped to hypothesize a metabolic disorder, which was subsequently confirmed by MRI.

show abstract

Diabetic Hemichorea-hemiballism after Prompt Improvement in Hyperglycemia

Cited by 9 publications

References 15 publications

Clinical features of hemichoreahemiballism: A stroke-related movement disorder

Clinical features of hemichoreahemiballism: A stroke-related movement disorder

Diabetic Striatopathy Complicated With Acute Ischemic Stroke: A Case Report

Diabetic Striatopathy: Parenchymal Transcranial Sonography as a Supplement to Diagnosis at the Emergency Department

Contact Info

Product

Resources

About