Hemichorea induced by diabetic ketoacidosis and striatal hyperdensity on computerized axial tomography
Hemichorea induced by diabetic ketoacidosis and striatal hyperdensity on computerized axial tomography
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计算机轴向断层扫描糖尿病酮症酸中毒和纹状体高密度诱发的偏侧舞蹈症
DOI：
10.33588/rn.3403.2001339
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发表时间：
2002
期刊：
影响因子：
--
通讯作者：
Edmeia Teresa Dos Santos Monteiro
中科院分区：
文献类型：
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作者：
M. Romero Blanco;Gil Santos Guerreiro João;Edmeia Teresa Dos Santos Monteiro
简介：高血糖（通常不是酮症）可能会导致偏侧舞蹈症。这种病理生理综合征的机制尚不清楚。它通常发生在老年女性中，并且与患侧对侧纹状体区域的高密度相关，在 T1 中 CT 和 MR 增强。临床病例：入院前三天，86 岁女性出现左肢、特别是左臂急性舞蹈样运动。未服用抗精神病药物，无舞蹈病家族史。神经系统检查没有其他异常发现。实验室检查显示高血糖、代谢性酸中毒和尿酮体。 CT扫描显示右侧纹状体区域有一个高密度病变，但这并不构成占位性病变。开始使用静脉注射胰岛素进行治疗，48 小时后症状消失。结论：我们强调偏侧舞蹈症与糖尿病酮症酸中毒之间关联的罕见性。从对其中一些患者进行的组织学研究来看，纹状体区域的高密度似乎可能是由于继发于小缺血性病变的肥大星形胶质细胞的增殖所致。当高血糖得到治疗后，舞蹈病会在几天内消失，并且很少需要抗精神病药物治疗。对于偏侧舞蹈症，应排除高血糖以及结构性原因（肿瘤、梗塞、血肿、创伤性病变等）。
INTRODUCTION: Hyperglycaemia, usually not ketotic, may cause hemichorea hemiballism. The mechanism of this physiopathological syndrome is still not clear. It usually occurs in elderly ladies and is associated with hyperdensity in the striate area contralateral to the affected side, on CT and MR potentiated in T1. CLINICAL CASE: Three days before hospital admission, and 86 year old woman presented with the acute onset of choreiform movements of her left limbs, particularly her left arm. She had not taken neuroleptic drugs and there was no family history of chorea. On neurological examination there were no other unusual findings. Laboratory tests showed hyperglycemia with metabolic acidosis and ketone bodies in the urine. On the CT scan there was a hyperdense lesion in the right striate area, but this did not act as a space occupying lesion. Treatment was started with intravenous insulin and the symptoms disappeared 48 hours later. CONCLUSIONS: We emphasize the rarity of the association of hemichorea and diabetic ketoacidosis. From the histological studies done in some of these patients, it seems that the hyperdensity of the striate area may be due to the proliferation of hypertrophic astrocytes secondary to small ischemic lesions. When the hyperglycaemia is treated, the chorea disappears within a few days and it is unusual for neuroleptic treatment to be required. In cases of hemichorea, hyperglycaemia should be ruled out, as should structural causes (tumors, infarcts, hematomas, traumatic lesions, etc.).