Session Information
Date: Wednesday, June 7, 2017
Session Title: Choreas (Non-Huntington’s Disease)
Session Time: 1:15pm-2:45pm
Location: Exhibit Hall C
Objective: To report a series of magnetic resonance image (MRI) study and advise the initial putaminal petechial hemorrhage following with gliosis as the cause of striatal hyperintensity on T1-weighted MRI in a patient with hyperglycemic chorea
Background: Non-ketotic hyperglycemia is a common cause of hemiballism-hemichorea (HB-HC), especially among elderly diabetic patients in Asia. The unique radiological pictures in the acute stage of this kind of dyskinesia revealed a contralateal striatal hyperintensity in the computed tomography (CT) scan and the T1-weighted magnetic resonance image (MRI) of the brain. However, the exact pathophysiology underlying this kind of dyskinesia is still controversial.
Methods: Case report
Results: A 64-year-old man with treated NIDDM suddenly developed an acute onset of the HB-HC of the right extremities. There was neither a remarkable history of drug intake nor contributory past or family history. Blood glucose concentration was 786 mg/dl (normal range, 70 – 120 mg/dl) and blood osmolarity was 319 mOsm/kg. No ketones were detected. Unenhanced brain CT showed a hyperdense lesion over the left putamen. MRI of brain, taken 2 days after onset of dyskinesia, revealed a hyperintensity on T1-weighted image in the left putamen and hypointensity on T2-weighted image, but no signal change was found in DWI image. His dyskinesia was well controlled by metabolic control and medication with haloperidol 7.5 mg daily. However, recurrence of his right HB-HC was noticeable after withdrawal from his medication 3 months later, despite his was still good. Follow-up brain MRI revealed hyperintensity in both T1- and T2-weighted image in the left putamen and loss of signal in gradient-echo T2-weighted image (T2-SWAN). The restoration of adequate haloperidol dosage made his dyskinesia well controlled.
Conclusions:
In this reported case, absence of signal change in DWI-image favored non-ischemic process in this kind of dyskinesia. Transformation of hypointensity to hyperintensity in T2-weighted image 3 month later suggested an absorbed hemorrhage, following with gliosis in the putamen. Meanwhile, iron deposition in the putamen cause loss of signal in T2-SWAN image. Therefore, we advised an initial putaminal patechial hemorrhage following with gliosis as the cause of striatal hyperintensity on T1-weighted MRI in this patient with hyperglycemic chorea.
References: Nil
To cite this abstract in AMA style:
J.-J. Lin. Evidence of putaminal petechial hemorrhage as the cause of hyperglycemic chorea [abstract]. Mov Disord. 2017; 32 (suppl 2). https://www.mdsabstracts.org/abstract/evidence-of-putaminal-petechial-hemorrhage-as-the-cause-of-hyperglycemic-chorea/. Accessed May 16, 2025.« Back to 2017 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/evidence-of-putaminal-petechial-hemorrhage-as-the-cause-of-hyperglycemic-chorea/