[Two diabetics with hemichorea-hemiballism and striatal lesions]

Abstract

We report two diabetic patients with hemichorea-hemiballism associated with striatal lesions detected by MRI. Case 1 was a 57-year-old woman. On May 5, 1990, hemichorea-hemiballism of the right upper extremity developed suddenly. The blood glucose level at the time of onset was 695 mg/dl. Plain cranial CT scanning revealed a small high-density lesion in the left putamen. On MRI, this lesion showed a high signal intensity on T1-weighted images, while it showed as an irregular low-intensity area on T2-weighted images. Three and a half months later, the high intensity lesion on MRI decreased gradually and almost disappeared. Case 2 was a 68-year-old woman. In late August 1992, hemichorea-hemiballism of the right upper and lower extremities developed suddenly. The blood glucose level at the time of onset was 365 mg/dl. Plain cranial CT scanning was normal. MRI revealed a high signal intensity lesion involving the left putamen, globus pallidus and head of the caudate nucleus on T1-weighted images, while the lesion was almost isointense on T2-weighted images. The high-intensity lesion on MRI thereafter decreased gradually and disappeared almost completely one year after the onset. It is characteristic that the lesions responsible for hemichorea-hemiballism showed high-intensity areas on T1-weighted MRI in these two diabetics. In the hyperglycemic state, the Krebs cycle is inhibited and GABA is utilized as an energy source. The possibility has been suggested that striatal ischemia is likely to occur in diabetics because the GABA content of the corpus striatum is decreased by hyperglycemia.(ABSTRACT TRUNCATED AT 250 WORDS)