Recovery of nonketotic hyperglycaemic hemichorea -hemiballismus due to acute ischemic stroke in the contralateral supplementary motor area: a case report and literature review.

IF 1.5 4区 医学 Q4 NEUROSCIENCES
Xiuyu Du, Xiaochuan Guo, Xiaobao Zhou
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Abstract

Introduction: There remains uncertainty about the mechanism and specific location of the relative cortex with nonketotic hyperglycaemic hemichorea-hemiballismus (HC-HB). This paper aims to analyse the relationship between the disappearance of HC-HB and the supplementary motor area (SMA) infarction in a patient who recovered following an acute ischemic stroke.

Case presentation: An 83-year-old female patient with diabetes mellitus presenting with severe and refractory involuntary movement after hypoglycaemic therapy was referred to an outpatient neurosurgery department for further intervention. Laboratory, magnetic resonance imaging (MRI) and computed tomography (CT) neuroimaging and physical examinations were performed. After a diagnosis of HC-HB was confirmed, the patient received hypoglycaemic therapy and haloperidol; however, there was no significant improvement. Brain MRI T1-weighted images and CT scans showed high signal intensity involving the bilateral putamen nucleus. CT perfusion and CT angiography showed a hypo-perfusion in the SMA of the right hemisphere without significant vascular occlusion. Then, aspirin and clopidogrel were administered, and the patient's left leg presented slight involuntary movement three days later. Interestingly, her involuntary movement disappeared again on the second day after the discontinuation of antiplatelet therapy. She was discharged three days later, and her symptoms did not recur during a follow-up for three months.

Conclusions: The SMA dysfunction caused by the acute infarction could terminate or reset the pathological neural path-way of nonketotic hyperglycaemic HC-HB and contribute to the disappearance of the involuntary movement on the contralateral side. The SMA may be a selective intervention target for patients with refractory nonketotic hyperglycaemic HC-HB.

急性缺血性脑卒中导致对侧辅助运动区非酮症性高血糖血球症的恢复:病例报告和文献综述。
导言:关于非酮症性高血糖血球症(HC-HB)相对皮质的机制和具体位置仍存在不确定性。本文旨在分析一名急性缺血性中风后康复的患者 HC-HB 消失与辅助运动区(SMA)梗死之间的关系:一名 83 岁的女性糖尿病患者在接受低血糖治疗后出现严重的难治性不自主运动,被转诊至神经外科门诊部接受进一步干预。患者接受了实验室、磁共振成像(MRI)和计算机断层扫描(CT)神经影像学检查和体格检查。确诊为 HC-HB 后,患者接受了低血糖治疗和氟哌啶醇治疗,但病情没有明显改善。脑部核磁共振 T1 加权成像和 CT 扫描显示,双侧普坦核有高信号强度。CT灌注和CT血管造影显示右半球SMA灌注不足,但无明显血管闭塞。随后,患者服用了阿司匹林和氯吡格雷,三天后左腿出现轻微的不自主运动。有趣的是,在停止抗血小板治疗的第二天,她的不自主运动又消失了。三天后患者出院,随访三个月后症状未再出现:结论:急性脑梗塞导致的 SMA 功能障碍可终止或重置非酮症高血糖 HC-HB 的病理神经通路,并促使对侧不自主运动消失。SMA可能是难治性非酮症高血糖性HC-HB患者的选择性干预目标。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Folia neuropathologica
Folia neuropathologica 医学-病理学
CiteScore
2.50
自引率
5.00%
发文量
38
审稿时长
>12 weeks
期刊介绍: Folia Neuropathologica is an official journal of the Mossakowski Medical Research Centre Polish Academy of Sciences and the Polish Association of Neuropathologists. The journal publishes original articles and reviews that deal with all aspects of clinical and experimental neuropathology and related fields of neuroscience research. The scope of journal includes surgical and experimental pathomorphology, ultrastructure, immunohistochemistry, biochemistry and molecular biology of the nervous tissue. Papers on surgical neuropathology and neuroimaging are also welcome. The reports in other fields relevant to the understanding of human neuropathology might be considered.
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