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Abstract

Chorea-ballismus with nonketotic hyperglycemia in primary diabetes mellitus.

P H Lai, R D Tien, M H Chang, M M Teng, C F Yang, H B Pan, C Chen, J F Lirng and K W Kong
American Journal of Neuroradiology June 1996, 17 (6) 1057-1064;
P H Lai
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R D Tien
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M H Chang
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M M Teng
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C F Yang
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H B Pan
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C Chen
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J F Lirng
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K W Kong
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Abstract

PURPOSE To describe the neuroimaging (Ct, MR, and single-photon emission CT [SPECT]) findings in a series of patients with chorea-ballismus associated with nonketotic hyperglycemia in primary diabetes mellitus and to correlate the imaging findings with the clinical presentation.

METHODS The neuroimaging and clinical data from 10 patients with chorea-ballismus associated with nonketotic hyperglycemia in primary diabetes mellitus were evaluated. Family and drug histories, as well as other causes of chorea, were excluded. All 10 patients had CT, 5 also had MR imaging, and 3 had SPECT examinations. Three had follow-up CT and MR imaging studies, and MR findings were correlated with CT findings in 5 cases. Two experienced neuroradiologists, aware of the diagnosis but blinded to the clinical status of the patients, evaluated all images and reached a consensus as to the final interpretation.

RESULTS CT studies in 9 of 10 patients showed a hyperdense putamen and/or caudate nucleus; in 1, the CT findings were normal. T1-weighted MR images in all 5 patients who had MR imaging (including the patient with a normal CT study) showed hyperintense lesions without significant T2 signal alternation at the basal ganglia. In all 3 of the patients who had SPECT studies of the brain, the scans revealed hypoperfusion at corresponding areas. All 3 follow-up studies depicted resolution of the lesions in the abnormal basal ganglia. Increased hypointensity on T2-weighted and gradient-echo T2*-weighted images was also observed in the sequential MR images. In all patients, the initial side of involvement correlated well with the neuroimaging findings. The chorea resolved within 2 days after treatment of the hyperglycemia in 9 patients.

CONCLUSION In patients with chorea-ballismus associated with nonketotic hyperglycemia in primary diabetes mellitus, CT and T1-weighted MR images show unilateral or bilateral lesions of the putamen and/or caudate. SPECT scans show hypoperfusion. These findings may be related to petechial hemorrhage and/or myelin destruction. Early recognition of these imaging characteristics may facilitate diagnosis of primary diabetes mellitus with hyperglycemia and prompt appropriate therapy.

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American Journal of Neuroradiology
Vol. 17, Issue 6
1 Jun 1996
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Chorea-ballismus with nonketotic hyperglycemia in primary diabetes mellitus.
P H Lai, R D Tien, M H Chang, M M Teng, C F Yang, H B Pan, C Chen, J F Lirng, K W Kong
American Journal of Neuroradiology Jun 1996, 17 (6) 1057-1064;

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Chorea-ballismus with nonketotic hyperglycemia in primary diabetes mellitus.
P H Lai, R D Tien, M H Chang, M M Teng, C F Yang, H B Pan, C Chen, J F Lirng, K W Kong
American Journal of Neuroradiology Jun 1996, 17 (6) 1057-1064;
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