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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 25:975-976, June-July 2004
© 2004 American Society of Neuroradiology

Case Report
BRAIN

Unilateral Putaminal CT, MR, and Diffusion Abnormalities Secondary to Nonketotic Hyperglycemia in the Setting of Acute Neurologic Symptoms Mimicking Stroke

Max Wintermark^a,b, Nancy J. Fischbein^a, Pratik Mukherjee^a, Esther L. Yuh^a and William P. Dillon^a

^a Department of Radiology, Neuroradiology Section, University of California, San Francisco
^b the Department of Diagnostic and Interventional Radiology, University Hospital Center, Lausanne, Switzerland

Address correspondence and reprint requests to Max Wintermark, MD, Department of Diagnostic and Interventional Radiology, University Hospital Center, CHUV-BH07, CH-1011 Lausanne, Switzerland

Summary: A 75-year-old Asian man presented with two episodes of chorea associated with nonketotic hyperglycemia. His chorea rapidly resolved after restitution of a normal serum glucose level, although an MR image obtained at the time of acute symptoms demonstrated high signal intensity on T1-weighted images, low signal intensity on T2-weighted images, and restricted diffusion, all involving the left putamen. A CT scan obtained 1 month later demonstrated faint hyperattenuation of the involved putamen. The reported pathophysiologic considerations for these imaging features are reviewed, and an original explanation is proposed.