A Case of the Syndrome of Acute Bilateral Basal Ganglia Lesions due to Hypoglycemia in Hemodialysis Patient.
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Date
2013-01
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Abstract
Patients with chronic kidney disease may have neurological complications including
uremic encephalopathy, stroke, neuropathy and myopathy. Rarely, acute movement
disorder associated with bilateral basal ganglia lesion is seen in patients with end stage
kidney disease. The hallmarks of this condition include reversible and uniform lesions of
the basal ganglia on MRI which stand for decreased signal intensity on T1-weighted
images and increased signal intensity on T2-weighted images, and the clinical
presentation includes acute parkinsonism and/or involuntary movements. This syndrome
has been reported mainly in Asian patients, typically in the setting of long-standing
diabetes. We report a case of bilateral basal ganglia lesions in a patient with chronic
renal failure, poorly controlled diabetes, and incidents of severe hypoglycemia.
In our case, there was no evidence of acute metabolic disorders. Most reported patients
with acute basal ganglia lesions in uremia also had diabetes and/or abnormal blood
glucose levels. Our case had previously experienced occasional hypoglycemia before
the onset of involuntary choreic movements. MRI of our patient showed acute bilateral
basal ganglia lesion, corresponding to cytotoxic edema. This pattern was also observed in patients with hypoglycemic encephalopathy.
Description
Keywords
Acute bilateral basal ganglia syndrome, chorea, diabetes, hypoglycemia, uremia
Citation
Gwoo Sangeon, Kim Ye Na, Shin Ho Sik, Jung Yeon Soon, Rim Hark. A Case of the Syndrome of Acute Bilateral Basal Ganglia Lesions due to Hypoglycemia in Hemodialysis Patient. British Journal of Medicine and Medical Research. 2013 Jan-Mar; 3(1): 69-74.