Basal ganglia hyperdensity on computerised tomography of brain : a rare finding of non-ketotic hyperglycemia
Hyperdensity of basal ganglia in computed tomography (CT) of brain is alwaysrecognised as hemorrhagic stroke or calcification. Features of hyperglycemia include muscle weakness, hypotonia, pyramidal tract signs and hemichorea-hemiballismus (HC-HB), which mimic the symptoms of stroke. Hyperdensity...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Pusat Perubatan Universiti Kebangsaan Malaysia
2018
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| Online Access: | http://journalarticle.ukm.my/20630/ http://journalarticle.ukm.my/20630/1/29_ms0259_pdf_16881.pdf |
| Summary: | Hyperdensity of basal ganglia in computed tomography (CT) of brain is alwaysrecognised as hemorrhagic stroke or calcification. Features of hyperglycemia
include muscle weakness, hypotonia, pyramidal tract signs and hemichorea-hemiballismus (HC-HB), which mimic the symptoms of stroke. Hyperdensity of
the basal ganglia was reported in patient with non-ketotic hyperglycemia (NKH).
Inability to recognize the hyperdensity in CT brain as a feature of NKH may lead to
failure of treatment. Early recognition and reversal of hyperglycemia will improve
the outcome. This was a case of an atypical presentation of stroke-like symptoms
with the neuroimaging finding showing asymmetric hyperdensity of basal ganglia.
Neurological examination failed to elicit any sign of HC-HB. Laboratory test
showed hyperglycemia with absence of acidosis and ketonaemia. The patient was
diagnosed having basal ganglia hemorrhage and referred to the Neurosurgical
team. However, the stroke-like symptoms completely resolved following the
normalization of glucose level. This is the only other reported case of NKH with
typical neuroimaging features not associated with HC-HB. One should be aware
of the possibility of NKH in the absence of movement disorder with asymmetric
basal ganglia hyperdensity in CT brain. Misinterpretation as acute intracranial
bleeding may result in suboptimal management of the true underlying cause. |
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