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

• DOI: 10.1210/jc.2014-2576
• Publication Date: 2014-10-14T16:49:09Z
• Authors: Junko Nagai; Tsutomu Yamada; Xia Cao; Ayako Fukui; Machiko Tajitsu; Fumiko Yamakawa; Yuko Yambe; Takashi Murase; Masashi Watanabe; Fumio Shimada
• Keywords: Magnetic resonance angiography

Although there are reports of hyperintense lesions in hyperglycemic hemichorea-hemiballism by brain magnetic resonance imaging (MRI) (1, 2), such findings angiography (MRA) rare. An 82-year-old man presented with a 1-month history left-sided involuntary movements his face and limbs. Laboratory data revealed blood glucose level 20.8 mmol/L, glycosylated hemoglobin 11.5%, serum C-peptide 2.20 ng/mL. There were no urinary ketones or metabolic acidosis. T1-weighed MRI showed lesion the putamen caudate nucleus, whereas cranial MRA an irregular perivascular arteriostenosis middle cerebral artery (MCA) (Figure 1A, arrows). After diagnosis hemichorea-hemiballism, he was treated insulin. Upon correction levels, ballistic improved. At follow-up visit, abnormal areas had improved slightly 1B), they disappeared completely at 6-month visit 1C). His to 7.6%. Hyperglycemic is more common among patients type 2 diabetes, Asians, elderly. Possible underlying mechanisms include microhemorrhages due blood-brain-barrier failure (3), reactive astrocytes associated ischemia (4), decreased -aminobutyric acid production after dehydration (5), present as high-intensity signal on MRI. We observed high intensity MRA, along stenosis MCA bifurcation lenticulostriate arteries, which supply nucleus. This suggests that these have vascular fragility vulnerable disorders hyperglycemia.