糖尿病性偏侧舞蹈症的临床分析

Clinical analysis of Hemichorea associated with diabetic hyperglycemia

目的探讨糖尿病性偏侧舞蹈症的临床特点、发病机制、影像学改变及预后,防止误诊及漏诊。方法回顾性分析10例糖尿病性偏侧舞蹈症的临床症状、影像学变化、实验室检查结果和治疗经过,并复习相关文献。结果①10例均为未经治疗的糖尿病患者,其中6例为糖尿病非酮症高血糖症,4例为酮症高血糖症。②临床表现;7例为突发起病并以一侧肢体为主的持续性舞蹈样运动,3例为发作性口角抽动伴单肢不自主舞动起病。症状均清醒时出现,睡眠时消失。肌力均为5级,肌张力均正常。③影像学表现:早期CT表现为舞蹈症状对侧的尾状核、壳核和(或)苍白球,丘脑的高密度影像,内囊未受累,并在1个月左右减弱或消失;磁共振(MRI) T_1像为病灶部位的片状高信号,在持续数月后信号减低,T_2则表现为稍低信号或病灶部位区域中心混杂信号而周边高信号,边界清晰,无明显水肿征象。④本组患者均给予氟哌啶醇及氯硝安定等药物治疗并控制血糖,症状均在短期内迅速改善。结论糖尿病性偏侧舞蹈症多见于血糖控制不佳的糖尿病患者,结合特定部位的变化性磁共振成像及肢体舞蹈样动作可以做出诊断。在控制血糖的基础上,应用氟哌啶醇和氯硝安定治疗效果较好。

Objective To investigate the clinical characteristic,pathogenesis,imaging features and prognosis ofhemichorea associated with hyperglycemia in primary diabetes mellitus(DM),and,to keep from misdiagnosing.Methods Retrospect and analyze the clinical manifestations,the neuroimaging features,results of examining in laboratory and the treatment of the ten patients with hemichorea induced by hyperglycaemia in primary DM,and review the literatures about this disease.Results①All of the ten cases had a long history of uncontrolled diabetes,among whom,six were no-ketotic hyperglycemic patients and four were ketotic hyperglycemic patiant.②Clinical manifestation:Seven of them had an acute and durative hemichorea,which was majoring in one side of limbs.Three of them had onset twitch in mouth and hemicborea in a single limb.All of the symptom almost occurred during awakeness and ceased during sleep.The muscle force was 5,and,the muscular tension was normal,in the ten cases.③Imaging features:The early CT findings in this Disorder were high density in the caudate nucleus,putamen and/or globus pallidus,thalamencephalon on the side contralateral to the involved limbs,but not in internal capsule,and showed decreased attenuation or completely disappeared in about a month.T_1WI in all cases showed high signal intensities without edema ormass effect in the diseasd region which decreased after several months,while the T2WI were slightly low signal intensities or motley signal intensities in the center of focus but high signal intensities outside the focus.(④)All cases were treated with Haloperidol and Clonazepam,based on controlling blood sugar.The symptom was catabatic in short order.Conclusion Hemicborea induced by hyperglycemia often happens in the patients with diabetic,which was not controlled better in blood sugar.Adding to variability and special imaging features in magnetic resonance, and bemichorea in one side of limbs,we can diagnose.Based on controlling blood sugar,Haloperidol and Clonazepam are the best medicine for Hemichorea induced by hyperglycemia,at present.