Hemichorea-hemiballism syndrome: A look through susceptibility weighted imaging

Abstract

Hemichorea-hemiballism syndrome (HCHB) is a relatively rare cause of unilateral chorea in diabetic patients and is due to non ketotoic hyperglycaemia. Characteristic magnetic resonance (MR) findings include T1 hyperintensity in the contralateral putamen without any significant signal alteration on other conventional MR sequences. We report susceptibility weighted imaging (SWI) findings in a case of HCHB syndrome.

Keywords: Diabetes; hemichorea-hemiballism; putamen; susceptibility.

Figure 1 (a-d)

Axial T1W MR image (a) shows hyperintense signal in left lentiform nucleus. No significant signal abnormality is seen on axial T2W (b), FLAIR (c) or DW (d) images

Figure 2 (a-d)

Axial SWI images show hyperintense signal in left lentiform nucleus. Symmetrical hypointensities are seen in bilateral globus palidii suggesting age-related mineralization (black arrows in 2a). Asymmetrical hypointensity is also seen in posterolateral aspect of left putamen indicating mineral deposition (white arrow in 2a). Prominent vessels appearing hypointense of SWI are seen along left sylvian fissure (white arrows in 2b) and in left temporal region (white arrow in 2c). Axial minimum intensity projection (MinIP) SWI image (2d) again shows prominent hypointense vessels along left sylvian fissure and in left temporal region to better advantage