%0 Journal Article
%T Susceptibility Weighted Imaging as a Useful Imaging Adjunct in Hemichorea Hyperglycaemia
%A Ferry Dharsono
%A Andrew Thompson
%A Jolandi van Heerden
%A Andrew Cheung
%J Case Reports in Radiology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/456156
%X Hyperglycaemia with hemichorea (HGHC) is an unusual clinical entity that can be associated with corpus striatum hyperintensity on T1-weighted (T1W) magnetic resonance imaging (MRI) sequences. We report the utility of the susceptibility weighted image (SWI) sequence and the filtered phase SWI sequence in the imaging assessment of HGHC. 1. Case Report A 54-year-old man presented to the emergency department with a 5-day history of right-sided HemiChorea on a background of type II diabetes and hypertension. There was no personal or family history of movement disorders and no history of neuroleptic drug use. At presentation, serum blood glucose level was 36.2£żmmol/L with an HbA1c of 16%. There was no ketonuria. The hemichorea resolved with optimal blood glucose control. Initial nonenhanced CT (NECT) head demonstrated increased attenuation in the left corpus striatum, corresponding to hyperintensity on T1W MRI. There was no evidence of acute infarction on diffusion weighted imaging (DWI). The SWI sequence showed asymmetric hypointensity within the left lentiform nucleus, with sparing of the caudate nucleus (Figures 1(a)¨C1(d)). All MR studies were performed on a 1.5T superconducting MR imaging system (Aera; Siemens, Erlangen, Germany). Figure 1: MRI changes in the left corpus striatum related to hemichorea hyperglycaemia. Top row: initial MRI head shows abnormal hyperintensity in the left caudate head and left putamen on axial and coronal T1W MRI (a) and (b). Asymmetric low signal was noted along the lateral margin of the left putamen on SWI (c). On NECT head (d) there is corresponding increased attenuation in the left corpus striatum. Bottom row: MRI head performed five months later shows volume loss of the entire left corpus striatum, cystic foci of malacic change in the posterolateral putamen along with partial resolution of the hyperintensity on axial and coronal T1W MRI (e) and (f). There was progression in extent and degree of hypointensity within the left corpus striatum on SWI (g) with corresponding hyperintensity on filtered phase SWI (h). Surveillance MRI at five months revealed volume loss of the entire left corpus striatum with partial resolution of the hyperintensity on T1W MRI, particularly at the caudate head. Small cystic foci of malacic change were demonstrated within the left posterolateral putamen. The SWI sequence revealed interval progression in the extent and degree of hypointensity in the left lentiform nucleus and caudate head. SWI hypointensity corresponded to areas of hyperintensity on the filtered phase SWI sequence (Figures
%U http://www.hindawi.com/journals/crira/2013/456156/