A Case of Diabetic Hemichorea with Pathological Changes on Cranial MRI and MR Spectroscopy (MRS)

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  • 頭部MRIおよび磁気共鳴スペクトロスコピー（MRS）にて病変を観察した糖尿病性片側舞踏病の1例
  • 症例報告 頭部MRIおよび磁気共鳴スペクトロスコピー(MRS)にて病変を観察した糖尿病性片側舞踏病の1例
  • ショウレイ ホウコク トウブ MRI オヨビ ジキ キョウメイ スペクトロスコピー(MRS)ニテ ビョウヘン オ カンサツ シタ トウニョウビョウセイ カタガワ ブトウビョウ ノ 1レイ

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An 81-year-old woman was diagnosed with type 2 diabetes mellitus at 65 years of age. Over the six-month period before being introduced to our hospital, the patient's treatment was interrupted. One week before admission, remarkable involuntary movements in the right arm were noted, and hyperglycemia, with a plasma glucose level of 498 mg/dl and HbA1c level of 14.1 %, was detected. On the day of admission, the patient developed chorea in the right arm in addition to nonketotic hyperglycemia and slight hyperosmolarity. Cranial MRI demonstrated high intensity in the left putamen on T1-weighted imaging (WI), with normal intensity on T2WI, T2*WI and diffusion WI. Diabetic hemichorea was diagnosed, excluding the possibility of cerebral hemorrhage and/or infarction. MRS revealed a low N-acetylaspartate/creatine ratio in the left putamen, suggesting neural damage. The chorea subsequently disappeared under conditions of glycemic control achieved with insulin therapy. In addition, the high-intensity area on MRI T1 was attenuated 111 days later. In this case, the onset of diabetic hemichorea due to neural damage in the left putamen was speculated to be caused by the patient's hyperosmolar hyperglycemic state.

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