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Diffusion-Weighted and Gradient Echo Magnetic Resonance Findings of Hemichorea-Hemiballismus Associated With Diabetic Hyperglycemia
A Hyperviscosity Syndrome?
Kon Chu, MD;
Dong-Wha Kang, MD, PhD;
Dong-Eog Kim, MD;
Seong-Ho Park, MD, PhD;
Jae-Kyu Roh, MD, PhD
Arch Neurol. 2002;59:448-452.
Background The magnetic resonance (MR) imaging findings of hemichorea-hemiballismus
(HCHB) associated with hyperglycemia are characterized by hyperintensities
in the striatum on T1-weighted MR images and computed tomographic scans, with
a mechanism of petechial hemorrhage considered to be responsible. Diffusion-weighted
MR imaging (DWI) has been reported to detect early ischemic damage (cytotoxic
edema) as bright areas of high signal intensity and vasogenic edema as areas
of heterogeneous signal intensity. We report various DWI findings in 2 patients
with hyperglycemic HCHB.
Objectives To describe the DWI and gradient echo findings and characterize the
types of edema in HCHB associated with hyperglycemia.
Setting A tertiary referral center neurology department.
Design and Methods Two patients with HCHB associated with hyperglycemia underwent DWI,
gradient echo imaging, and conventional MR imaging with gadolinium enhancement.
The patients had an elevated serum glucose level on admission and a long history
of uncontrolled diabetes, and the symptoms were controlled by dopamine receptor
blocking agents. Initial DWIs were obtained 5 to 20 days after symptom onset.
Apparent diffusion coefficient (ADC) values were measured in the abnormal
lesions with visual inspection of DWI and T2-weighted echo planar images.
Results T1- and T2-weighted MR images and brain computed tomographic scans showed
high signal intensities in the right head of the caudate nucleus and the putamen.
Gradient echo images were normal. The DWIs showed bright high signal intensity
in the corresponding lesions (patient 1), and the ADC values were decreased.
The decrease in ADC and the high signal intensity on DWI persisted despite
the disappearance of HCHB, even after 70 days.
Conclusions Gradient echo MR imaging findings were normal in HCHB with hyperglycemia,
whereas DWI and the ADC map showed restricted diffusion, which suggests that
hyperviscosity, not petechial hemorrhage, with cytotoxic edema can cause the
observed MR abnormalities.
From the Department of Neurology and Clinical Research Institute, Seoul
National University Hospital, Neuroscience Research Institute of Seoul National
University Medical Research Center (Drs Chu, Kang, Kim, and Roh), and Department
of Neurology, Seoul Boramae Municipal Hospital (Dr Park), Seoul, South Korea;
and Section on Stroke Diagnostics and Therapeutics, National Institute of
Neurological Disorders and Stroke, Bethesda, Md (Dr Kang).
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