Presentation of striatal hyperintensity on T1-weighted MRI in patients with hemiballism-hemichorea caused by non-ketotic hyperglycemia: Report of seven new cases and a review of literature

Abstract

Recent studies have shown unique clinicoradiologic characteristics in patients with hemiballism-hemichorea (HB-HC) caused by non-ketotic hyperglycemia; however, there is still a limited number of patients being reported. We report 7 patients (3 males and 4 females) with this type of dyskinesia, whose ages ranged from 60 to 84 years. Brain CT of these patients showed hyperdensity in the contralateral striatum, corresponding with MRI studies that showed an increased signal intensity on T1-weighted images and a decreased signal on T2-weighted images. After metabolic control had been achieved, the hyperkinetic state of these patients abruptly ceased. Follow-up neuroimaging studies in 2 patients documentied complete resolution of the striatal hyperintensity on brain CT and MRI after 3 months and 6 months, respectively. A review of patients with HB-HC caused by non-ketotic hyperglycemia reported formerly and in the present study shows that the dyskinesia tends to occur in aged diabetic patients. The age of patients with dyskinesia secondary to cerebral infarction is generelly much lower. We also found that 86% (30 out of 35 cases) patients reported with HB-HC caused by non-ketotic hyperglycemia were Asians. The prognosis of the dyskinesia was excellent, and the radiological abnormalities are completely reversible.

Hemichorea after stroke: Clinical-radiological correlation

“…■ Key words hemichorea · stroke · striatum · subthalamic nucleus · cerebral cortex set) hemichorea or mixed involuntary movements [8]; 2) hyperkinetic motor behaviors contralateral to hemiplegic limbs [4]; 3) the presence of moderate or severe positional sensory loss (see below) in the involved limb [22]; 4) normal brain CT or MRI findings (two patients); 5) multiple recent ischemic lesions on brain CT or MRI; 6) hemichorea caused by hereditary diseases, hyperthyroidism, systemic lupus erythematosus, infections, medications, pregnancy, neoplastic diseases, and hematological disorders; 7) hemichorea associated with diabetes mellitus [1,12,13,18], which was defined when i) a markedly elevated blood glucose level at the onset of hemichorea; ii) a hyperintensive lesion in the contralateral striatum on brain T1-weighted MRI or CT; iii) an abrupt cessation of the hemichorea after the control of hyperglycemia; iv) no evidence of acute cerebrovascular or inflammatory lesions on brain MRI or CT [13]. Patients' muscle strength was graded by the Medical Research Council (MRC) 0 to V strength scale, and clumsiness without definitive weakness was designated as V -.…”

Hyperglycemia-induced unilateral basal ganglion lesions with and without hemichorea A PET study

“…Hyperglycemia-induced hemiballism-hemichorea (HB-HC) is an unusual clinical entity that occurs mostly in aged Asian patients with poorly controlled diabetes mellitus [10][11][12]. A characteristic signal abnormality in the basal ganglion region is evident on these patients' neuroimages.…”

Hemibalismo-hemicoreia em estado hiperglicêmico não cetótico: distúrbio do movimento associado ao diabetes melito

“…Exames de imagem descrevem mais frequentemente hiperdensidade (TC) ou hiperintensidade (ressonância magnética em T1) no território do ramo lateral estriatal da artéria cerebral média (8). Os principais diagnósticos diferenciais dessas lesões nos gânglios da base são calcificações e hemorragia.…”

“…A análise histopatológica dessas lesões é conflitante, mostrando áreas de perda neuronal, gliose e astrocitose reativa (8). Mestre e cols.…”