Susceptibility Weighted Imaging Features of Nonketotic Hyperglycemia: Unusual Cause of Hemichorea‐Hemiballismus

Abstract

Nonketotic hyperglycemia has been described as a metabolic cause of Hemiballism-hemichorea (HB-HC), especially in elderly patients with poorly controlled diabetes. Pathophysiology is not known yet. MRI features tend to be hyperintense in the putamen on T1-weighted images. We present conventional MRI with diffusion weighted imaging (DWI) and susceptibility weighted imaging (SWI) features of two cases with nonketotic hyperglycemia. T1 hyperintensity without diffusion restriction on DWI and minimal putaminal hypointensity without phase shift on SWI were compatible with either pathological mineralization or petechial microhemorrhage or protein denaturation. In the type 2 diabetic patients with HC-HB, conventional MRI together with SWI and DWI will guide to clinician to plan treatment approach.

Non‐ketotic hyperglycaemia causing occipital seizures and persistent microhaemorrhages: mechanisms of focal deficits in hyperglycaemia

“…1 SWI hypointense foci have been noted in basal ganglia in cases of hemichoreahemiballismus associated with HHS, and proposed to be caused by microhaemorrhages through erythrocyte diapedis, or alternatively, protein-rich reactive astrocytes called gemistocytes. 5,6 In our case, the persistence of subcortical SWI changes is a new finding, and would argue for true microhaemorrhages, as gemistocytic changes are expected to be more transient. In hyperglycaemia, microhaemorrhages might arise through thrombosis, erythrocyte and/or endothelial changes within small veins or arterioles, below the resolution of CT or MR angiography or venography.…”

Acute Acquired Metabolic Encephalopathy Based on Diffusion MRI

“…Most patients with HONK usually show continuous, random, and involuntary movements of the unilateral, proximal, and distal muscle groups. This phenomenon is called hemichorea-hemiballism [ 20 21 22 23 24 ]. This is more common in elderly patients with uncontrolled diabetes mellitus and females because of estrogen [ 21 23 24 25 26 ].…”

“…In addition, the rich protein content of these cells leads to the restricted motion of water molecules, which is expressed as high signal intensity on DWI with a low apparent diffusion coefficient (ADC) value ( Fig. 4C, D ) [ 20 21 22 28 29 30 ]. The abnormal MRI findings were reversible.…”

Hemichorea–hemiballism: a case report

“…The classical MR scan findings are of T1-hyperintensity in the basal ganglia with variable T2-signal changes 2. However, MR scanning with susceptibility-weighted imaging does not always show susceptibility artefact.…”