糖尿病性偏侧舞蹈症的临床分析

【摘要】 目的探讨糖尿病性偏侧舞蹈症的临床特点、发病机制、影像学表现、治疗及预后。方法分析6例糖尿病性偏侧舞蹈症的临床症状、影像学变化、实验室检查结果和治疗经过,并复习相关文献。结果 (1)6例均为未经治疗的糖尿病患者,其中,4例为糖尿病非酮症高血糖症,2例为酮症高血糖症。(2)临床表现:所有病例均为突发一侧肢体舞蹈样运动,症状均清醒时出现,睡眠时消失。(3)影像学表现:早期CT表现为舞蹈症状对侧的尾状核、壳核和(或)苍白球的高密度影像,并在1个月左右减弱或消失。磁共振T1像为病灶部位的片状高信号,T2像则表现为低信号或高信号,无水肿征象。(4)本组患者中4例给予氟哌啶醇及氯硝安定等药物治疗,2例患者没有使用上述药物,但所有患者均给予控制血糖治疗,症状均在短期内迅速改善。结论糖尿病性偏侧舞蹈症多见于未系统控制血糖的糖尿病患者,结合特定部位的变化性影像成像及肢体舞蹈样动作可以做出诊断。通过控制血糖,症状可以短期缓解。是否服用氟哌啶醇和氯硝安定对于治疗效果无明显差异。更多还原

【Abstract】 Objective To investigate the clinical characteristic,pathogenesis,imaging features,therapy and prognosis of hemichorea associated with hyperglycemia in primary diabetes mellitus(DM).Methods analyze the clinical manifestations,the neuroimaging features,results of examining in Iaboratory and the treatment of the six patients with hemichorea induced by hyperglycemia in primary DM,and review the literatures about this disease.Results(1)All of the six cases had a long history of uncontrolled diabetes,among whom,four were non,ketotic hyperglycemic patients and two were ketotic hyperglycemic patient.(2)Clinical manifestation:All of them had an acute one side Hemichorea which was almost continuous during awakeness and ceased during sleep.(3) Imaging features:The earlye CT findings in this disorder were high density in the caudate nucleus,putamen and/or globus pallidus on the side contralateral to the involved limbs,and showed decreased attenuation or completely disappcared in about a month.T1WI in all cases showed high-signal intensities,while the T2WI showed low-signal or high-signal intensities without edema.(4)Four cases were treated with Haloperidol and Clonazepam,while two cases were not.But all sases were treaed based on controlling blood sugar.The symptom was catabatic in short time.Conclusion Hemichorea induced by hyperglycemia often happens in the patients poorly controlled DM.Adding to variability and special neuroimaging features,and hemichorea in one side of limbs,we can diagnose.Based on controlling blood sugar,symptom can catabatic in short time.There were no difference in the therapeutic efficacy of Hemichorea induced by hyperglycelmia,between the four cases were treated with Haloperidol and Clonazepam and the two cases were not.更多还原