DaT Scan “Abnormality” in Hyperglycemic-Hemichorea

Doher, Nicholas; Gupta, Harish

doi:10.5334/tohm.491

Cited by 4 publications

(7 citation statements)

References 15 publications

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Section: Resultsmentioning

confidence: 99%

“…Dopamine transporter (DaT) SPECT imaging in two case reports demonstrated decreased uptake contralateral to the affected side [ 49 50 ]. In both cases the patients did not demonstrate clinical parkinsonism and no follow up was reoirted to determine whether these patients went on to develop PD or if the DaT changes remained with resolution of their chorea [ 49 50 ]. One case speculated that the finding was clinically significant and represented true decreased presynaptic dopaminergic uptake [ 49 ] while the second suggested that the finding was secondary to structural changes in the basal ganglia related to the T1 changes on MRI [ 50 ].…”

Section: Resultsmentioning

confidence: 99%

“…In both cases the patients did not demonstrate clinical parkinsonism and no follow up was reoirted to determine whether these patients went on to develop PD or if the DaT changes remained with resolution of their chorea [ 49 50 ]. One case speculated that the finding was clinically significant and represented true decreased presynaptic dopaminergic uptake [ 49 ] while the second suggested that the finding was secondary to structural changes in the basal ganglia related to the T1 changes on MRI [ 50 ]. The bases for these speculations are unclear, and, in the absence of supporting evidence and more systemic studies, it would appear more likely that these patients had presymptomatic PD.…”

Section: Resultsmentioning

confidence: 99%

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One Side of the Story; Clues to Etiology in Patients with Asymmetric Chorea

Cincotta¹,

Walker

2022

Tremor and Other Hyperkinetic Movements

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Background: Chorea can be due to a large number of etiologies. Unilateral chorea is classically related to a contralateral structural lesion, e.g. of the putamen or subthalamic nucleus, however, based upon personal impressions, we have observed that systemic disease, in particular metabolic or autoimmune conditions, can also lead to a unilateral or markedly asymmetric presentations. We sought to investigate this impression by reviewing the literature. Methods: A PubMed search was conducted using the terms asymmetric” AND “chorea” OR “hemichorea” OR “unilateral” AND “chorea” OR “monochorea” OR “right greater than left” AND “chorea” OR “left greater than right” AND “chorea” OR “right more than left” AND “chorea” OR “left more than right” AND “chorea” as well as “hemiballismus” NOT “stroke” NOT “infarct” NOT “dyskinesia. A total of 243 sources were felt to meet criteria and were reviewed. Results: The most common etiology of reported hemi- or asymmetric chorea was diabetic non-ketotic hyperglycemic hemichorea/hemiballismus. Other common diagnoses were Sydenham’s disease, antiphospholipid syndrome and drug-induced chorea. The vast majority of patients with hemi- or asymmetric chorea had acquired rather than genetic, degenerative or congenital causes. Conclusion: Despite the potential limitations of our literature review, the evidence presented here supports the observation that the vast majority of asymmetric or unilateral chorea presentations are due to acquired causes, and in this situation an exhaustive search for reversible etiology should be undertaken. However, presentation with symmetric, generalized chorea does not exclude reversible causes, and investigations should address these in addition to genetic and neurodegenerative etiologies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

One Side of the Story; Clues to Etiology in Patients with Asymmetric Chorea

Cincotta¹,

Walker

2022

Tremor and Other Hyperkinetic Movements

View full text Add to dashboard Cite

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“…Some of the clinical-radiological discrepancies may be resolved with the help of SPECT study [14,15]. However, apparently superior and sophisticated investigations like DOI: 10.1159/000524936 dopamine transporter (DAT) (to detect dopaminergic integrity) and positron emission tomography scan (to detect a failure in metabolism in different substrates of basal ganglia) may not always be devoid of drawbacks [16,17]. The lesions involving the basal ganglia can lead to either a hypokinetic or hyperkinetic movement disorder depending on the involved pathway.…”

Section: Pathophysiological Basis Of Ds and Its Clinical And Neurorad...mentioning

confidence: 99%

“…The lesions involving the basal ganglia can lead to either a hypokinetic or hyperkinetic movement disorder depending on the involved pathway. Hence, a patient with a structural abnormality in the basal ganglia can have a hyperkinetic movement disorder despite an abnormal DAT scan [16].…”

Section: Pathophysiological Basis Of Ds and Its Clinical And Neurorad...mentioning

confidence: 99%

Neuroimaging of Diabetic Striatopathy: More Questions than Answers

Dubey

Biswas²,

Ghosh

et al. 2022

Eur Neurol

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Background: Diabetic striatopathy (DS), coined as a generic term, has been defined as a hyperglycemic condition associated with either one of the two following conditions: chorea/ballism or striatal hyperdensity on computed tomography or striatal hyperintensity on T1-weighted magnetic resonance imaging. This review highlights those “gray areas,” which need further exploration to understand better hyperglycemia-induced striatal changes and diverse movement disorder phenotypes associated with these changes. Results and Discussion: We searched in PubMed and Google Scholar the terms “diabetes mellitus,” “movement disorders,” “diabetic striatopathy,” “chorea,” “hemichorea,” “ballism,” “hemichorea-hemiballism,” and “neuroradiology” in various combinations (time range from 1980 to March 2022). We selected the publications about our topic of discussion. Summary: Hemichorea-hemiballismus is the most commonly associated movement disorder in DS, and the putamen is the most frequently affected anatomical region. The exact pathophysiological mechanisms remain elusive. Clinical-radiological discordance is not rare. Complete reversal of symptoms with the resolution of the imaging findings is the most prevalent outcome in patients with DS. Dramatic improvement of chorea can be achieved by either insulin monotherapy or combination therapy of insulin and D2-blocker or, in some cases, even spontaneously. Conclusion: The term “diabetic striatopathy” is ambiguous and controversial. Pathological mechanisms behind clinical-radiological discordance in hyperglycemia-induced striatopathy need further exploration through well-designed studies. We propose a classification of DS that includes symptomatic DS (striatal neuroimaging lesions in association with a clinically evident movement disorder and hyperglycemia), clinically isolated DS (clinically evident movement disorders without striatal changes in neuroimaging), and radiologically isolated DS.

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Striatal Hyperperfusion Observed in Dual-Phase 18F-FP-CIT PET Imaging of Hyperglycemic Chorea

Kim,

Park,

Shin

et al. 2023

Clin Nucl Med

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A 76-year-old woman with a history of diabetes mellitus presented with right-side dominant generalized chorea. At presentation, her blood glucose level was 500 mg/dL with an HbA1C of 11%. Because the patient had been on levodopa treatment from her primary physician, a dual-phase 18F-FP-CIT PET scan was performed. The early-phase images showed increased perfusion in the bilateral striatum, and the delayed-phase images revealed decreased uptake in the left caudate. Hyperperfusion in the striatum may indicate the acute phase of hyperglycemic chorea. This image illustrates the advantage of adding early-phase scans in 18F-FP-CIT PET in differentiating various hyperkinetic and hypokinetic disorders.

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DaT Scan “Abnormality” in Hyperglycemic-Hemichorea

Cited by 4 publications

References 15 publications

One Side of the Story; Clues to Etiology in Patients with Asymmetric Chorea

One Side of the Story; Clues to Etiology in Patients with Asymmetric Chorea

Neuroimaging of Diabetic Striatopathy: More Questions than Answers

Striatal Hyperperfusion Observed in Dual-Phase 18F-FP-CIT PET Imaging of Hyperglycemic Chorea

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