title: In vivo proton MR spectroscopy of chorea-ballismus in diabetes mellitus.
abstract: The most common cause of chorea-ballismus (CB) is a vascular lesion; it is also associated with nonketotic hyperglycaemia in diabetes mellitus (DM) and may be the first manifestation of this disorder. We describe the CT, MRI and proton MR spectroscopy (1H-MRS) of CB in eight patients. Six had hemichorea-hemiballismus (HC-HB) and two bilateral CB. Single-voxel (SV) 1H-MRS was performed using point-resolved spectroscopy (PRESS). Voxels were positioned in the basal ganglia of the patients and control subjects. PRESS was also used to obtain spectroscopic imaging (1H-MRSI) of the slice of interest in two patients. CT showed a slightly dense striatum in all the patients with CB, and T1-weighted images revealed high signal. The CB correlated well with the neuroimaging findings. SV 1H-MRS showed the mean (+/- SD) N-acetylaspartate (NAA)/ creatine (Cr) ratio to be 1.45 +/- 0.19 in HC-HB and 1.82 +/- 0.06 on the opposite normal side (P = 0.01). The choline (Cho)/ Cr ratio was 1.3 +/- 0.12 in HC-HB and 1.11 +/- 0.13 on the opposite normal side (P = 0.005). A lactate peak was seen in seven patients. The NAA/Cr ratio was 1.44 +/- 0.15 in bilateral CB and 1.74 +/- 0.16 in the controls (P = 0.017); the Cho/Cr ratios were 1.36 +/- 0.1 and 1.19 +/- 0.07 (P = 0.015). The low NAA/Cr suggests neuronal loss or damage and the high Cho/Cr probably indicates gliosis. The presence of lactate may suggest mild ischaemia due to acute vascular events during hyperglycaemia and underlying chronic focal cerebrovascular diseases in DM.
authors.affiliation: Department of Radiology, Veterans General Hospital-Kaohsiung, National Yang-Ming College, Taiwan. phlai@ksts.seed.net.tw
authors.forename: P H
authors.initials: PH
authors.lastname: Lai
authors.forename: P C
authors.initials: PC
authors.lastname: Chen
authors.forename: M H
authors.initials: MH
authors.lastname: Chang
authors.forename: H B
authors.initials: HB
authors.lastname: Pan
authors.forename: C F
authors.initials: CF
authors.lastname: Yang
authors.forename: M T
authors.initials: MT
authors.lastname: Wu
authors.forename: J Y
authors.initials: JY
authors.lastname: Li
authors.forename: C
authors.initials: C
authors.lastname: Chen
authors.forename: H L
authors.initials: HL
authors.lastname: Liang
authors.forename: W L
authors.initials: WL
authors.lastname: Chen
mesh_terms: D000368:Aged; D001224:Aspartic Acid / Q000031:analogs & derivatives* / Q000378:metabolism; D002794:Choline / Q000378:metabolism; D002819:Chorea / Q000175:diagnosis* / Q000209:etiology* / Q000378:metabolism; D003401:Creatine / Q000378:metabolism; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications*; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
chemical_list: D001224:Aspartic Acid; C000179:N-acetylaspartate; D003401:Creatine; D002794:Choline