In vivo proton MR spectroscopy of chorea-ballismus in diabetes mellitus

P. H. Lai*, P. C. Chen, M. H. Chang, H. B. Pan, C. F. Yang, M. T. Wu, J. Y. Li, C. Chen, H. L. Liang, W. L. Chen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

46 Scopus citations

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.

Original languageEnglish
Pages (from-to)525-531
Number of pages7
JournalNeuroradiology
Volume43
Issue number7
DOIs
StatePublished - 2001

Keywords

  • Chorea
  • Diabetes mellitus
  • Magnetic resonance spectroscopy

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