Hypoglycemic Encephalopathy Manifesting with Cortical Hemichorea-Hemiballismus Syndrome: A Case Report.

Autor: Pasini F; Department of Neurology, School of Medicine and Surgery, San Gerardo Hospital, ASST Monza, University of Milano-Bicocca, Monza, Italy., Karantzoulis A; Department of Neurology, School of Medicine and Surgery, San Gerardo Hospital, ASST Monza, University of Milano-Bicocca, Monza, Italy., Fanella G; Department of Neurology, School of Medicine and Surgery, San Gerardo Hospital, ASST Monza, University of Milano-Bicocca, Monza, Italy., Brovelli F; Department of Neurology, School of Medicine and Surgery, San Gerardo Hospital, ASST Monza, University of Milano-Bicocca, Monza, Italy., Iacobucci D; Department of Neurology, School of Medicine and Surgery, San Gerardo Hospital, ASST Monza, University of Milano-Bicocca, Monza, Italy., Aprea V; Department of Neurology, School of Medicine and Surgery, San Gerardo Hospital, ASST Monza, University of Milano-Bicocca, Monza, Italy., Storti B; Department of Neurology, School of Medicine and Surgery, San Gerardo Hospital, ASST Monza, University of Milano-Bicocca, Monza, Italy., Santangelo F; Department of Neurology, School of Medicine and Surgery, San Gerardo Hospital, ASST Monza, University of Milano-Bicocca, Monza, Italy., Canonico F; Department of Neuroradiology, San Gerardo Hospital, ASST Monza, Monza, Italy., Remida P; Department of Neuroradiology, San Gerardo Hospital, ASST Monza, Monza, Italy., Ferrarese C; Department of Neurology, School of Medicine and Surgery, San Gerardo Hospital, ASST Monza, University of Milano-Bicocca, Monza, Italy., Brighina L; Department of Neurology, School of Medicine and Surgery, San Gerardo Hospital, ASST Monza, University of Milano-Bicocca, Monza, Italy.
Jazyk: angličtina
Zdroj: Case reports in neurology [Case Rep Neurol] 2023 Feb 07; Vol. 15 (1), pp. 24-30. Date of Electronic Publication: 2023 Feb 07 (Print Publication: 2023).
DOI: 10.1159/000528880
Abstrakt: Hyper-/hypoglycemic states are rare but well-established causes of hyperkinetic movements, including chorea and ballismus, usually associated with brain lesions in the basal ganglia. We report a case of hemichorea-hemiballismus (HCHB) syndrome that developed after a severe hypoglycemic episode in a 71-year-old man with poorly controlled type 2 diabetes mellitus. Uncommonly, brain MRI showed contralateral cortical-subcortical T2 and T2-FLAIR-hyperintense frontoparietal lesions, with cingulate gyrus involved, while the basal ganglia were unaffected. In patients with hypoglycemic encephalopathy associated with cortical lesions, the long-term prognosis is usually poor. Nevertheless, in our patient, the dyskinesias and the cerebral lesions progressively regressed by achieving good glycemic control. After four and 12 months, the patient's neurological examination was normal. To our knowledge, this is the first evidence of hypoglycemic etiology of cortical HCHB syndrome, supporting recent theories that cortical circuitries may independently contribute to the pathogenesis of chorea and ballismus. This is also the first report of cingulate gyrus involvement in hypoglycemic encephalopathy. Finally, this case may indicate that a subset of patients with cortical lesions due to hypoglycemia could present a good clinical outcome, likely depending on the size of the lesions and the duration and severity of the hypoglycemic episode.
Competing Interests: The authors have no conflicts of interest to declare.
(© 2023 The Author(s). Published by S. Karger AG, Basel.)
Databáze: MEDLINE
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