Unilateral putaminal CT, MR, and diffusion abnormalities secondary to nonketotic hyperglycemia in the setting of acute neurologic symptoms mimicking stroke.
A 75-year-old Asian man presented with two episodes of chorea associated with nonketotic hyperglycemia. His chorea rapidly resolved after restitution of a normal serum glucose level, although an MR image obtained at the time of acute symptoms demonstrated high signal intensity on T1-weighted images, low signal intensity on T2-weighted images, and restricted diffusion, all involving the left putamen. A CT scan obtained 1 month later demonstrated faint hyperattenuation of the involved putamen. The reported pathophysiologic considerations for these imaging features are reviewed, and an original explanation is proposed.
Wintermark
Max
M
Department of Radiology, Neuroradiology Section, University of California, San Francisco, USA.
Fischbein
Nancy J
NJ
Mukherjee
Pratik
P
Yuh
Esther L
EL
Dillon
William P
WP
D000368:Aged; D002819:Chorea / Q000175:diagnosis / Q000209:etiology; D003937:Diagnosis, Differential; D006801:Humans; D020158:Hyperglycinemia, Nonketotic / Q000150:complications / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D011699:Putamen / Q000000981:diagnostic imaging* / Q000473:pathology*; D020521:Stroke / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed