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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2016; 74(04): 354-355
DOI: 10.1590/0004-282X20160021
IMAGES IN NEUROLOGY

Diabetic hemichorea-hemiballismus with nonketotic hyperglicemia: a rare cause of hyperkinetic movement disorders

Hemibalismo-hemicoreia associada à hiperglicemia não-cetótica: uma rara causa de distúrbios hipercinéticas do movimento
Lucas Giansante Abud
1   Documenta,Hospital São Francisco, Divisão de Neurorradiologia,Ribeirão PretoSP,Brazil;
2   Universidade de São Paulo,Hospital das Clínicas,Faculdade de Medicina de Ribeirão Preto, Divisão de Neurorradiologia Diagnóstica,Ribeirão PretoSP,Brazil;
,
Thiago Giansante Abud
1   Documenta,Hospital São Francisco, Divisão de Neurorradiologia,Ribeirão PretoSP,Brazil;
3   Universidade Federal de São Paulo,Departamento de Radiologia,São PauloSP,Brazil;
,
Rodolfo Mendes Queiroz
1   Documenta,Hospital São Francisco, Divisão de Neurorradiologia,Ribeirão PretoSP,Brazil;
,
Giovanni Salton Pietroni
1   Documenta,Hospital São Francisco, Divisão de Neurorradiologia,Ribeirão PretoSP,Brazil;
,
Daniel Giansante Abud
4   Universidade de São Paulo,Hospital das Clínicas,Faculdade de Medicina de Ribeirão Preto, Divisão de Neurorradiologia Intervencionista,Ribeirão PretoSP,Brazil.
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A 67-year-old woman was admitted with right hemichorea-hemiballismus. Blood glucose: 831 mg/dl. Magnetic resonance imaging (MRI) showed signal change in the left striatum ([Figures 1] and [2]).

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Figure 1 A) Sagittal T1- weighted magnetic resonance imaging showing spontaneous diffuse high intensity of the left striatum (caudate nucleus and putamen). B and C) There is no significant enhancement on axial and coronal T1-weighted MRI after intravenous paramagnetic contrast administration.
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Figure 2 A and B) Axial T2*-weighted gradient-echo MRI showing multiple confluent foci of hypointensities in left striatum probably due to petechial hemorrhage. C) There is no significant signal change on axial diffusion-weighted image.

This entity is characterized by hyperintensity confined to the striatum on T1-weighted MRI and contralateral hyperkinetic movement disorders in diabetic patients (type 2) with non-ketotic hyperglycemia[1]. T2*-weighted gradient-echo MRI can reveal low signal intensity related to petechial hemorrhage[2]. Pathological studies demonstrated selective neuronal loss, gliosis, reactive astrocytosis and hemorrhage[3].

The clinical symptoms usually improve markedly following the correction of hyperglycemia. Thus, the prompt recognition of this potentially treatable disease is of paramount importance.



Publication History

Received: 06 July 2015

Accepted: 20 October 2015

Article published online:
06 September 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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