糖尿病偏侧舞蹈症临床及影像学特点分析

Clinical and imaging characteristics of diabetic hemichorea

目的探讨糖尿病偏侧舞蹈症的临床表现、影像学特征及患者预后, 以提高该病的正确诊治率。方法收集陕西省人民医院神经内一科自2019年5月至2022年2月确诊的8例糖尿病偏侧舞蹈症患者的临床资料, 回顾性分析其临床表现、影像学特征及随访12个月后患者转归情况, 同时结合文献分析该病的发病机制。结果 8例患者均为女性, 其中5例既往有糖尿病史。7例为非酮症糖尿病偏侧舞蹈症(HC-NH), 1例为酮症糖尿病偏侧舞蹈症。7例患者表现为偏侧舞蹈症状, 1例患者表现为双侧舞蹈症状;6例出现挤眉弄眼、噘嘴伸舌等面部异常。8例患者发病时随机血糖为(22.1±3.17) mmol/L, 平均糖化血红蛋白为(11.8±1.67)%, 尿糖为+~++++。5例患者行头颅CT检查, 基底节高密度影1例。8例患者均行头颅MRI检查, 双侧病灶2例, 单侧病灶6例;基底节区T1像均为高信号。8例患者经控制血糖及对症治疗后病情均好转, 7例患者随访12个月未复发;1例患者缓解2个月后复发, 经治疗后随访12个月未再复发。结论血糖控制不达标的老年女性糖尿病患者发病率相对较高, 结合基底节区的特征性影像改变及偏侧舞蹈症状可明确诊断。在控制血糖基础上联合应用多巴胺受体阻滞剂氟哌啶醇及苯二氮类镇静药氯硝西泮可有效改善患者预后。

Objective To explore the clinical manifestations,imaging characteristics,and prognoses of diabetic hemichorea to improve the correct diagnosis and treatment rates.Methods The clinical data of 8 patients with confirmed diagnosis of diabetic hemichorea in our hospital from May 2019 to February 2022 were collected;and their clinical symptoms,imaging characteristics,and prognoses at 12 months of follow-up were analyzed retrospectively,and the related literature was consulted too to analyze the pathogenesis of diabetic hemichorea.Results All 8 patients were female,including 5 with a history of diabetes;7 patients were with hemichorea associated with non-ketotic hyperglycemia(HC-NH),and 1 patient was with hemichorea associated with ketotic hyperglycemia.Seven patients were with hemichorea symptoms,and 1 patient was with bilateral chorea symptoms;6 patients were with facial abnormalities such as making eyes,tapir mouth and persistent lingual protrusion.At disease onset,the mean random blood glucose was(22.1±3.17)mmol/L,mean glycosylated hemoglobin was(11.8±1.67)%,and urine glucose was(+)-(++++).Cranial CT was performed in 5 patients,and high density in basal ganglia was found in 1 patient.Head MRI showed high signal intensity in T1 of basal ganglia,with unilateral signal intensity in 6 patients and bilateral signal intensity in 2.After controlling blood glucose and symptoms,the condition of these 8 patients got improvement.Seven patients had no recurrence at 12 months of follow-up;1 patient relapsed after 2 months of remission and did not relapse after treatment during the 12 months of follow-up.Conclusions Incidence of diabetic hemichorea is relatively high in elderly female diabetic patients whose blood glucose control is not up to standard.By combining with characteristic imaging changes of basal ganglia and hemichorea symptoms,the diagnosis can be made clearly.On the basis of blood glucose control,the combination of dopamine receptor blocker haloperidol and benzodiazepine sedative clonazepam can effectively improve the prognosis.