Neuroimaging in uncontrolled hyperglycemia: a case series and literature review
Abstract Background There are wide-ranging differential diagnoses for the myriad of neurological symptoms associated with non-ketotic hyperglycemia. Similarly, various secondary complications of diabetic ketoacidosis present with nonspecific clinical symptoms. These are inadvertently misdiagnosed as...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2024-02-01
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| Series: | The Egyptian Journal of Radiology and Nuclear Medicine |
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| Online Access: | https://doi.org/10.1186/s43055-024-01195-1 |
| _version_ | 1797275381549498368 |
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| author | Serene Balaji Panneer Ayush Jain |
| author_facet | Serene Balaji Panneer Ayush Jain |
| author_sort | Serene Balaji Panneer |
| collection | DOAJ |
| description | Abstract Background There are wide-ranging differential diagnoses for the myriad of neurological symptoms associated with non-ketotic hyperglycemia. Similarly, various secondary complications of diabetic ketoacidosis present with nonspecific clinical symptoms. These are inadvertently misdiagnosed as epilepsies and strokes with associated hyperglycemia. Direct association between these nonspecific symptoms and hyperglycemia has been proved by demonstrating their resolution with correction of the latter. This case series portrays the spectrum of few rare neuroimaging findings of uncontrolled hyperglycemia, which helps in proper and prompt diagnoses. Case presentation Five diabetic patients with uncontrolled hyperglycemia were observed. Striatal hyperdensity on computed tomography or striatal T1 hyperintensity on magnetic resonance imaging was observed in three patients who presented with movement disorders. The abnormality was bilateral in one case. These observations were consistent with hyperglycemia-induced hemichorea–hemiballismus syndrome. In another patient who had presented with focal seizures, magnetic resonance imaging revealed subcortical T2/FLAIR hypointensity in bilateral occipital regions, which has been described to be characteristic for non-ketotic hyperglycemia-related seizures. Yet another patient who had been treated for diabetic ketoacidosis had developed bilateral lower-limb weakness. In correlation with a background of rapid correction of hyponatremia, magnetic resonance imaging revealed symmetric areas of altered signal intensity in the bilateral perirolandic region showing an open ring pattern of diffusion restriction, suggesting extrapontine myelinolysis. Conclusions In all the cases, the clinical differentials were wide. Neuroimaging was mandatory in establishing hyperglycemia as the underlying cause for the movement disorders and seizures. Also, neuroimaging aided in timely identification of extra-pontine myelinolysis, which might have prevented further central pontine involvement in the patient with diabetic ketoacidosis. |
| first_indexed | 2024-03-07T15:13:33Z |
| format | Article |
| id | doaj.art-e8c786d496224df6b631c758da570935 |
| institution | Directory Open Access Journal |
| issn | 2090-4762 |
| language | English |
| last_indexed | 2024-03-07T15:13:33Z |
| publishDate | 2024-02-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | The Egyptian Journal of Radiology and Nuclear Medicine |
| spelling | doaj.art-e8c786d496224df6b631c758da5709352024-03-05T18:03:49ZengSpringerOpenThe Egyptian Journal of Radiology and Nuclear Medicine2090-47622024-02-015511810.1186/s43055-024-01195-1Neuroimaging in uncontrolled hyperglycemia: a case series and literature reviewSerene Balaji Panneer0Ayush Jain1Department of Radiodiagnosis, Srinivas Institute of Medical Sciences & Research CentreDepartment of Radiology, Primus Super Speciality HospitalAbstract Background There are wide-ranging differential diagnoses for the myriad of neurological symptoms associated with non-ketotic hyperglycemia. Similarly, various secondary complications of diabetic ketoacidosis present with nonspecific clinical symptoms. These are inadvertently misdiagnosed as epilepsies and strokes with associated hyperglycemia. Direct association between these nonspecific symptoms and hyperglycemia has been proved by demonstrating their resolution with correction of the latter. This case series portrays the spectrum of few rare neuroimaging findings of uncontrolled hyperglycemia, which helps in proper and prompt diagnoses. Case presentation Five diabetic patients with uncontrolled hyperglycemia were observed. Striatal hyperdensity on computed tomography or striatal T1 hyperintensity on magnetic resonance imaging was observed in three patients who presented with movement disorders. The abnormality was bilateral in one case. These observations were consistent with hyperglycemia-induced hemichorea–hemiballismus syndrome. In another patient who had presented with focal seizures, magnetic resonance imaging revealed subcortical T2/FLAIR hypointensity in bilateral occipital regions, which has been described to be characteristic for non-ketotic hyperglycemia-related seizures. Yet another patient who had been treated for diabetic ketoacidosis had developed bilateral lower-limb weakness. In correlation with a background of rapid correction of hyponatremia, magnetic resonance imaging revealed symmetric areas of altered signal intensity in the bilateral perirolandic region showing an open ring pattern of diffusion restriction, suggesting extrapontine myelinolysis. Conclusions In all the cases, the clinical differentials were wide. Neuroimaging was mandatory in establishing hyperglycemia as the underlying cause for the movement disorders and seizures. Also, neuroimaging aided in timely identification of extra-pontine myelinolysis, which might have prevented further central pontine involvement in the patient with diabetic ketoacidosis.https://doi.org/10.1186/s43055-024-01195-1Non-ketotic hyperglycemiaHemichorea–hemiballismus syndromeSeizureSubcortical T2 hypointensityExtrapontine myelinolysisNeuroimaging |
| spellingShingle | Serene Balaji Panneer Ayush Jain Neuroimaging in uncontrolled hyperglycemia: a case series and literature review The Egyptian Journal of Radiology and Nuclear Medicine Non-ketotic hyperglycemia Hemichorea–hemiballismus syndrome Seizure Subcortical T2 hypointensity Extrapontine myelinolysis Neuroimaging |
| title | Neuroimaging in uncontrolled hyperglycemia: a case series and literature review |
| title_full | Neuroimaging in uncontrolled hyperglycemia: a case series and literature review |
| title_fullStr | Neuroimaging in uncontrolled hyperglycemia: a case series and literature review |
| title_full_unstemmed | Neuroimaging in uncontrolled hyperglycemia: a case series and literature review |
| title_short | Neuroimaging in uncontrolled hyperglycemia: a case series and literature review |
| title_sort | neuroimaging in uncontrolled hyperglycemia a case series and literature review |
| topic | Non-ketotic hyperglycemia Hemichorea–hemiballismus syndrome Seizure Subcortical T2 hypointensity Extrapontine myelinolysis Neuroimaging |
| url | https://doi.org/10.1186/s43055-024-01195-1 |
| work_keys_str_mv | AT serenebalajipanneer neuroimaginginuncontrolledhyperglycemiaacaseseriesandliteraturereview AT ayushjain neuroimaginginuncontrolledhyperglycemiaacaseseriesandliteraturereview |