Radiological and pathological changes in hemiballism‐hemichorea with striatal hyperintensity

Abstract

We report CT and MRI findings in a 50-year-old AfricanAmerican woman with hemichorea-hemiballism (HCHB) and hyperglycemia with striatal hyperintensity. Histopathologic findings following autopsy are also described, and possible explanations for the MR findings of this unique syndrome are presented.

Clinical significance of T1-weighted MR images following transient cerebral ischemia

“…In our original hypothesis, we thought the high protein content in gemistocytes might explain the high signal changes [2]. Two autopsy reports following ours confirmed the presence of multiple infarcts surrounded by hypertrophic astrocytes in lesions with similar MR imaging findings [4,5]. Although animal experiments have not confirmed protein-containing lesions, they remain to be a possible mechanism in human.…”

Putaminal Changes before the Onset of Clinical Symptoms in Diabetic Hemichorea-hemiballism

“…The precise pathogenesis underlying the occurrence of putaminal abnormalities on CT and T1WI remains unclear. These radiological changes are primarily considered to involve increased reactive astrocytes in the basal ganglia, and it is also known that the lesions occasionally contain small areas of hemorrhage and/or infarction (4,5). In the present patient, DHC-HB relapsed even after the disappearance of the CT abnormality, which was observed prior to symptom onset.…”

Putaminal petechial haemorrhage as the cause of non-ketotic hyperglycaemic chorea: a neuropathological case correlated with MRI findings

“…In the latter case, the findings were not observed in other regions with an identical signal alternation, namely the pallidum. In a third report,3 calcium deposits and focal micro-haemorrhages were found in the lesioned putamen and caudate where a confluent area of infarction was also observed. Although calcium was observed only on non-recent infarction areas, an association with the signal changes on CT and MRI was postulated.…”

“…Regarding the signal changes observed on imaging studies, a critical appraisal of the published case reports with neuropathological results3 – 5 emphasises the heterogeneity of the available data in terms of the time delay in neuropathological specimen collection, neuropathological findings, timing of imaging studies, characteristics of basal ganglia findings and the presence of concurrent relevant lesions. In two reported cases,4 , 5 an association was postulated between the presence of reactive astrocytes and MRI changes.…”