Abstract
Hyperdensity of basal ganglia in computed tomography (CT) of brain is always recognised as hemorrhagic stroke or calcification. Features of hyperglycemia include muscle weakness, hypotonia, pyramidal tract signs and hemichoreahemiballismus (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.
Keywords :
Diabetes mellitus,
hyperglycemia,
neuroimaging,
stroke,
Abstrak
Hiperdensiti di ganglia basal dalam pengimejan tomografi (CT) otak selalunya dianggap sebagai strok hemoragik atau kalsifikasi dalam otak. Tanda-tanda hiperglisemia seperti kelemahan otot, hypotonia, gejala trak piramida dan hemichorea-hemiballismus (HC-HB), menyerupai gejala strok. Hiperdensiti di ganglia basal telah dilaporkan dalam pesakit dengan hiperglisemia non-ketotik (NKH). Ketidakupayaan untuk mengenalpasti hiperdensiti ini dalam CT otak sebagai tanda NKH boleh mengakibatkan kegagalan rawatan. Diagnosa awal dan rawatan hiperglisemia yang optimum akan mempercepatkan kadar pemulihan pesakit. Ini adalah kes atipikal gejala menyerupai strok dengan ciri-ciri neuroimaging yang menunjukkan hiperdensiti asimetri ganglia basal. Pemeriksaan neurologi tidak menunjukkan sebarang gejala HC-HB. Ujian makmal menunjukkan hiperglisemia tanpa asidosis dan ketonaemia. Pesakit disyaki mengalami pendarahan ganglia basal dan dirujuk kepada pakar pembedahan saraf dan otak. Walau bagaimanapun, gejala menyerupai strok yang dihidapi pesakit pulih sepenuhnya berikutan pembetulan tahap paras glukosa. Kes NKH ini merupakan kes kedua yang dilaporkan mempunyai ciri-ciri neuroimaging tipikal yang tidak dikaitkan dengan HC-HB. Kesedaran perlu ada terhadap kemungkinan NKH dalam ketiadaan gangguan pergerakan dengan hiperdensiti basal ganglia asimetrik di otak CT. Kesalahtafsiran sebagai pendarahan intrakranial akut boleh mengakibatkan pengurusan suboptimal.
Kata Kunci :
hiperglisemia,
kencing manis,
neuroimaging,
strok,
Correspondance Address
Ng Von How. Department of Emergency Medicine,
Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak,
56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-91455703 Email: ngvonhow@msn.com
