糖尿病合并偏侧舞蹈症的临床及影像学特点

Clinical and imaging features of diabetes complicated with hemichorea

目的探讨糖尿病合并偏侧舞蹈症的临床及影像学特点。方法回顾性分析6例糖尿病合并偏侧舞蹈症患者的临床资料。结果6例患者均在血糖控制不良的情况下急性起病,舞蹈样症状累及单侧肢体和/或面部,上肢为重;头颅CT显示出现舞蹈样症状肢体的对侧豆状核和/或尾状核早期呈高密度,MRIT1加权像呈高信号;2例DWI示病变处稍高信号;1例MRS示病灶处N-乙酰天冬氨酸/肌酸(NAA/Cr)低于对侧,胆碱/肌酸(Cho/Cr)高于对侧,出现乳酸(Lac)峰。经综合治疗(控制血糖、改善脑循环、抗氧自由基、以及口服氟哌啶醇、地西泮等)6例患者症状缓解。2周内复查,部分患者影像学有改善。结论糖尿病合并偏侧舞蹈症与糖尿病血糖控制不佳有关,影像学显示脑深部灰质核团损伤;提示中枢神经系统微细血管病变可能是由糖尿病导致的;综合治疗近期疗效较好。

Objective To investigate the clinical and imaging features of diabetes complicated with hemichorea. Methods The clinical data of 6 patients with diabetic complicated with hemichorea were analysed retrospectively. Results The 6 cases were acute onset with blood glucose controlled poorly. The hemichorea symptoms were involved unilateral limb and/or face, and more serious in upper limb. The high density lesions were found in lenticular and/or caudate nucleus opposite to the affected limbs in the early stage of the disease by crainal CT. Hyperintensc lesions in the basal ganglia were demonstrated by T1W1 of MRI. The lesions also showed slight hyperintense in 2 cases by DWI. The N-acetylaspartic acid/creatine （ NAA/Cr ） was lower and choline/creatine （Cho/Cr） was higher than the opposite side, and the peak of lactic acid （Lac） was obeseved in 1 case by MRS. The symptoms in the 6 cases were remission by combined therapy including to control blood glucose, improving the cerebral circulation, preventing oxygen free radical and taking drugs of Haloperidol, Diazepam etc. 2 weeks later, the imaging was improved in part of the cases. Conclusions Diabetes complicated with hemichorea is related with uncontrolled blood glucose. The imagings can show the damages at deep nucleus in brain. This suggest that the minuteness blood vessel damages in central nervous system may be caused by diabetes. The combined treatment can respond a better effect in the near future.