Session Information
Date: Wednesday, June 7, 2017
Session Title: Neuroimaging (Non-PD)
Session Time: 1:15pm-2:45pm
Location: Exhibit Hall C
Objective: To describe the unusual image findings and clinical manifestations of the syndrome of acute bilateral basal ganglia lesions in a diabetic uremic patient with hyperglycemia.
Background: The syndrome of acute bilateral basal ganglia lesions in diabetic uremia is uncommon and it usually affects middle to old-aged Asian patients. Clinical manifestations include acute dyskinesia and/or parkinsonism. The typical neuroimaging finding is reversible symmetrical basal ganglia lesions with cytotoxic and/or vasogenic edema. The clinical manifestation of nonketotic hyperglycemia induced involuntary movement is usually hemichorea or hemiballism. These patients often exhibit a contralateral striatal hyperdensity on computed tomography (CT) and/or hyperintense T1-weighted signal on magnetic resonance imaging (MRI). Imaging findings resolve after hyperglycemia correction.
Methods: Clinical observation and image examination for hyperglycemia associated dyskinesia in a diabetic uremic patient with acute bilateral basal ganglia lesions.
Results: A 32-year-old lady with history of type II diabetic mellitus, hypertension, old myocardial infarction post treatment of coronary artery bypass grafting, end stage renal disease under peritoneal dialysis for years. She suffered from writing difficulty after taking metoclopramide for 3 days. Truncal dyskinesia, right side predominant limbs chorea, cervical dystonia and abnormal gait gradually developed. Laboratory data showed hyperglycemia (sugar: 436 mg/dl). There was no obvious abnormal signal on brain CT but brain MRI showed symmetric mixed hypo- and hyperintensity in bilateral lentiform nuclei on T1-weighted images, and hyperintensity on T2-weighted images and FLAIR images[figure 1]. We controlled her sugar and kept regular dialysis, prescribing haloperidol and clonazepam but her symptoms still progressed to generalized dyskinesia.
Conclusions: We reported a young patient with the syndrome of acute bilateral basal ganglia lesions in diabetic uremia. Hyperglycemia and/or metoclopramide could be trigger factors. Hyperglycemia associated unilateral predominant chorea could demonstrate with symmetrical T1–hyperintense lesions in basal ganglia on brain MRI. Mixed hypo- and hyperintensity on T1-weighted MRI could present in the syndrome of acute bilateral basal ganglia lesions in diabetic uremia with hyperglycemia associated dyskinesia.
References: The syndrome of acute bilateral basal ganglia lesions in diabetic uremic patients.Wang HC, Cheng SJ.J Neurol. 2003 Aug;250(8):948-55.
Chorea associated with non-ketotic hyperglycemia and hyperintensity basal ganglia lesion on T1-weighted brain MRI study: a meta-analysis of 53 cases including four present cases. Oh SH, Lee KY, Im JH, Lee MS.J Neurol Sci. 2002 Aug 15;200(1-2):57-62.
To cite this abstract in AMA style:
P.-Y. Chen, A. Gutfreund, K. Brockmann, I. Wurster, G. Eschweiler, F. Metzger, W. Maetzler, D. Berg. Unusual MRI findings of the syndrome of acute bilateral basal ganglia lesions in diabetic uremia with hyperglycemia associated dyskinesia [abstract]. Mov Disord. 2017; 32 (suppl 2). https://www.mdsabstracts.org/abstract/unusual-mri-findings-of-the-syndrome-of-acute-bilateral-basal-ganglia-lesions-in-diabetic-uremia-with-hyperglycemia-associated-dyskinesia/. Accessed May 21, 2025.« Back to 2017 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/unusual-mri-findings-of-the-syndrome-of-acute-bilateral-basal-ganglia-lesions-in-diabetic-uremia-with-hyperglycemia-associated-dyskinesia/