糖尿病高渗偏身不自主运动ppt课件.ppt

非酮症性高血糖所致的舞蹈样投掷运动 non-ketotic hyperglycaemia induced chorea-ballism Hemiballism-hemichorea (HB-HC) A clinical spectrum of continuous, nonpatterned, and involuntary movements involving one side of the body Focal vascular lesion in the contralateral basal ganglia Metabolic derangements (e. g., non-ketotic hyperglycemia or hyperthyroidism) brain neoplasm infectious diseases of the central nervous system (e. g., human immunodeficiency virus infection) non-ketotic hyperglycemia is the second most common cause of HB-HC Presentation of striatal hyperintensity on T1-weighted MRI in patients with hemiballism-hemichorea caused by non-ketotic hyperglycemia: Report of seven new cases and a review of literature. J Neurol (2001) 248 presentation of ballistic or choreiform movements of at least two of the unilateral face, neck, upper limb and lower limb regions; a markedly elevated blood glucose level at the onset of HB-HC; (3)a hyperintensive lesion in the contralateral striatum on brain CT and/or MRI; (4)an abrupt cessation of the dyskinesia after achieving hyperglycemic control; (5)no evidence of acute cerebrovascular, infectious, or inflammatory lesions on brain CT and/or MRI; (6)no evidence of other metabolic derangement, recreational drug use, or a known history of degenerative disorder. Diagnosis of non-ketotic hyperglycemia hyperosmolar syndrome (NKHHS) was made based on the observation of hyperglycemia (blood sugar levels greater than 500 mg/dl), the absence of ketonemia and a serum osmolality greater than 350 mmol/kg 1995年一例74岁老年女性，急性起病，左舞蹈动作。血糖296mg/dl，血渗透压296mOmsm/L.尿酮阴性，尿糖阳性。舞蹈动作持续了37天，T1高信号、T2低信号持续10个月消失。SPECT显示为高灌注。作者推测为小梗死和钙沉积为MRI异常信号的原因。 1999年一例，症状同样，偏侧舞蹈。MRI信号同前例，但有强化，强化范围同T1异常信号区域。推测BBB破坏在先，然后形成类似MRI异常信号区。 2001年，92岁男性。症状、影像学同前。尸检证实：多灶性小梗死灶、反应性胶质增生、神经元间反应（interneuronal response. ） 1999年另一例，22岁。症状同前。CT示稍高密度影。MRI同前。 2001年5例。诱因及症状均同前。４例为以前未发现患糖尿病。症状持续6月到5年，病程2天～1月。４例有典型的MRI表现，一例无明显MRI异常信号灶。  2004年，有人对此病的为微量出血的