摘要
目的探讨糖尿病性偏侧舞蹈症的临床表现、发病机制及特殊的影像学变化。方法分析了3例糖尿病性偏侧舞蹈症患者的临床症状、影像变化及治疗经过,并复习相关文献。结果3例均为未经治疗的糖尿病患者,其中2例为糖尿病非酮症高血糖症,1例为酮症高血糖症。舞蹈样症状均为突发起病且以一侧肢体为主,清醒时出现,睡眠时消失。早期CT表现为舞蹈症状对侧的尾状核、壳核和(或)苍白球的高密度影像,并在1个月左右减弱或消失;磁共振(MRI)T1像为病灶部位的片状高信号,在持续数月后信号减低,T2则表现为多变信号,边界清晰,无水肿征象。结论糖尿病性偏侧舞蹈症多见于糖尿病控制不佳的高血糖症患者,糖尿病酮症及非酮症均可发病。病变部位以纹状体为主,其早期CT表现为高密度影,MRIT1像为高信号、T2像为多变信号。认识这种突发的舞蹈症状及影像变化有利于糖尿病高血糖症的早期诊断与治疗。
Objective To investigate the clinical manifestation,pathogenesis and imaging features of hemichorea associated with hyperglycemia in primary diabetes mellitus（DM）. Methods Analyze the clinical manifestations, the neuroimaging features and the treatment of the three patients with hemichorea induced by hyperglycaemia in primary DM, and review the literatures about this disease. Results All of the three cases had a long history of uncontrolled diabetes,among whom,two were non-ketotic hyperglycemic patients and one was ketotic hyperglycemic patient. All of them had an acute onset hemichorea which was almost continuous during awakeness and ceased during sleep. The early CT findings in this disorder were high density in the caudate nucleus, putamen and/or globus pallidus on the side contralateral to the involved limbs,but showed decreased attenuation or completely resolved in about a month. T1-weighted MR images in all cases showed high-signal intensities without edema or mass effect in the diseased region which decreased after several months, while the T2-weighted images were more variable. Conclusion Hemichorea induced by hyperglycemia often happens in the patients with poorly controlled DM, and both of the non-ketotic hyperglycemic and the ketotlc hyperglycemic state can be the cause. In the major affected reglon-corpora striata, CT shows hyperdense lesions, TI -weighted MR images show hyperintense lesions and T2-weighted images show variable lesions in the early time.
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2007年第13期1057-1060,共4页
Chinese Journal of Practical Internal Medicine
