Chorea-ballismus with nonketotic hyperglycemia in primary diabetes mellitus

Ping Hong Lai, Robert D. Tien, Ming Hong Chang, Michael M.H. Teng, Chien Fang Yang*, Huay Ben Pan, Clement Chen, Jiing Feng Lirng, Koon Wah Kong

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

152 Scopus citations


PURPOSE: To describe the neuroimaging (CT, MR, and single-photon emission CT [SPECT]) findings in a series of patients with chorea-ballismus associated with nonketotic hyperglycemia in primary diabetes mellitus and to correlate the imaging findings with the clinical presentation. METHODS: The neuroimaging and clinical data from 10 patients with chorea-ballismus associated with nonketotic hyperglycemia in primary diabetes mellitus were evaluated. Family and drug histories, as well as other causes of chorea, were excluded. All 10 patients had CT, 5 also had MR imaging, and 3 had SPECT examinations. Three had follow-up CT and MR imaging studies, and MR findings were correlated with CT findings in 5 cases. Two experienced neuroradiologists, aware of the diagnosis but blinded to the clinical status of the patients, evaluated all images and reached a consensus as to the final interpretation. RESULTS: CT studies in 9 of 10 patients showed a hyperdense putamen and/or caudate nucleus; in 1, the CT findings were normal. T1- weighted MR images in all 5 patients who had MR imaging (including the patient with a normal CT study) showed hyperintense lesions without significant T2 signal alternation at the basal ganglia. In all 3 of the patients who had SPECT studies of the brain, the scans revealed hypoperfusion at corresponding areas. All 3 follow-up studies depicted resolution of the lesions in the abnormal basal ganglia. Increased hypointensity on T2-weighted and gradient-echo T2*-weighted images was also observed in the sequential MR images. In all patients, the initial side of involvement correlated well with the neuroimaging findings. The chorea resolved within 2 days after treatment of the hyperglycemia in 9 patients. CONCLUSION: In patients with chorea- ballismus associated with nonketotic hyperglycemia in primary diabetes mellitus, CT and T1-weighted MR images show unilateral or bilateral lesions of the putamen and/or caudate. SPECT scans show hypoperfusion. These findings may be related to petechial hemorrhage and/or myelin destruction. Early recognition of these imaging characteristics may facilitate diagnosis of primary diabetes mellitus with hyperglycemia and prompt appropriate therapy.

Original languageEnglish
Pages (from-to)1057-1064
Number of pages8
JournalAmerican Journal of Neuroradiology
Issue number6
StatePublished - 1996


  • Chorea
  • Diabetes mellitus
  • Hyperglycemia


Dive into the research topics of 'Chorea-ballismus with nonketotic hyperglycemia in primary diabetes mellitus'. Together they form a unique fingerprint.

Cite this