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Junko Nagai, Tsutomu Yamada, Xia Cao, Ayako Fukui, Machiko Tajitsu, Fumiko Yamakawa, Yuko Yambe, Takashi Murase, Masashi Watanabe, Fumio Shimada, Cranial Magnetic Resonance Imaging and Angiography Findings in a Patient With Hyperglycemic Hemichorea-Hemiballism, The Journal of Clinical Endocrinology & Metabolism, Volume 100, Issue 1, 1 January 2015, Pages 11–12, https://doi.org/10.1210/jc.2014-2576
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Although there are reports of hyperintense lesions in hyperglycemic hemichorea-hemiballism by brain magnetic resonance imaging (MRI) (1, 2), such findings by magnetic resonance angiography (MRA) are rare.
An 82-year-old man presented with a 1-month history of left-sided involuntary movements of his face and limbs. Laboratory data revealed a blood glucose level of 20.8 mmol/L, glycosylated hemoglobin of 11.5%, and serum C-peptide of 2.20 ng/mL. There were no urinary ketones or metabolic acidosis. T1-weighed brain MRI showed a hyperintense lesion in the putamen and caudate nucleus, whereas cranial MRA showed an irregular perivascular hyperintense lesion and an arteriostenosis in the middle cerebral artery (MCA) (Figure 1A, arrows). After a diagnosis of hyperglycemic hemichorea-hemiballism, he was treated with insulin. Upon correction of blood glucose levels, the ballistic movements improved. At the 1-month follow-up visit, the abnormal hyperintense areas had improved slightly (Figure 1B), and they had disappeared completely at the 6-month follow-up visit (Figure 1C). His glycosylated hemoglobin improved to 7.6%.
