Acute bilateral basal ganglia lesions in diabetic uraemia: diffusion-weighted MRI.
METHODS
We studied four patients with diabetes mellitus and chronic renal failure who developed sudden choreic movement disorders. The clinical manifestations, laboratory findings, MR imaging findings, and clinical outcome in each patient were evaluated.


RESULTS
All four patients had long-term diabetes mellitus and severe azotaemia. Brain MR findings consisted of bilateral symmetric basal ganglia lesions, with decreased signal intensity on T1-weighted images and increased signal intensity on T2-weighted images. All three patients who underwent diffusion-weighted MR imaging (DWI) showed signal intensities similar to those of the surroundings in regions corresponding to increased signal intensity on T2-weighted images, with slightly increased apparent diffusion coefficient (ADC) values. Two of the patients showed small focal areas of restricted diffusion within the basal ganglia lesions. After haemodialysis, follow-up MR imaging in all patients demonstrated that the basal ganglia lesions had regressed markedly, with some residual changes. The movement disorders also improved in all patients.


CONCLUSIONS
A syndrome associated with acute bilateral basal ganglia lesions in diabetic uraemic patients is rare, with reversible changes demonstrated by clinical and imaging findings. DWI showed that the bilateral basal ganglia lesions in this syndrome were primarily vasogenic in origin, although there were small foci of cytotoxic oedema within the lesions.
Lee
Eun Ja
EJ
Department of Radiology, Myongji Hospital, Kwandong University, College of Medicine, 697-24, Hwajung-Dong, Dukyang-Gu, Koyang-City, Gyunggi-Do, 412-270, Republic of Korea, ejl1048@hanmail.net.
Park
Jong-Ho
JH
Ihn
Yon kwon
Yk
Kim
Young Joo
YJ
Lee
Seon Kyu
SK
Park
Chan Sup
CS
D000208:Acute Disease; D000328:Adult; D001480:Basal Ganglia Diseases / Q000209:etiology / Q000473:pathology*; D002819:Chorea / Q000209:etiology / Q000473:pathology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003928:Diabetic Nephropathies / Q000150:complications / Q000628:therapy; D038524:Diffusion Magnetic Resonance Imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D014511:Uremia / Q000150:complications* / Q000628:therapy