非酮症性高血糖合并偏侧舞蹈症一例

患者男性,72岁.因右侧肢体不自主舞动2个月于2009年8月17日入院.既往:糖尿病史8年,间断口服二甲双胍,血糖控制不稳定.右侧肢体不自主舞动,呈持续性,睡眠后消失.     

非酮症性高血糖合并偏侧舞蹈症一例

患者男性,72岁.因右侧肢体不自主舞动2个月于2009年8月17日入院.既往:糖尿病史8年,间断口服二甲双胍,血糖控制不稳定.右侧肢体不自主舞动,呈持续性,睡眠后消失.     

非酮症高血糖性偏侧舞蹈症一例报道

非酮症高血糖（HG）性偏侧舞蹈症（HC-NH）是DM罕见并发症,早期诊治预后良好。报道1例以HG起病的女性患者,右侧肢体舞蹈样动作,磁共振成像示对侧基底节区T1WI高信号,治疗后病情好转。HC-NH易误诊、漏诊,临床需提高认识。     

非酮症高血糖合并偏侧舞蹈症1例

<正>1病例患者女,50岁,因突发左侧上肢不自主运动6 d,于2012年11月26日入院。于入院前6 d无明显诱因出现左侧肢体不自主运动,表现为上肢关节时而屈曲,时而伸直,时而扭转,不停耸肩,下肢有不随意运动,症状较轻,能自行行走,静止时上述症状无好转,夜间难以入睡。无面部挤眉、弄眼、皱额等动作。至当地医院就诊,颅脑MRI考虑豆状核变性,末梢血糖为25.2mmol/L。给予输液治疗(具体药物不     

非酮症性高血糖合并偏侧舞蹈症3例报告

非酮症性高血糖多可表现为多种神经功能障碍，其中偏侧舞蹈症是其少见的临床表现之一。近年来，我们收治3例非酮症性高血糖合并偏侧舞蹈症（HC-NH）。现择其中2例报告如下。     

非酮症性高血糖偏侧舞蹈症一例的影像学动态变化

非酮症性高血糖偏侧舞蹈症(HC-NH)的发病机制目前尚不明确,其影像学特点为症状肢体对侧基底节区CT及MRI T1加权序列高信号.作者报道了1例老年非酮症性高血糖偏侧舞蹈症患者,并动态追踪了其影像学变化,以期加深临床医师对非酮症性高血糖偏侧舞蹈症影像学变化的了解.     

非酮症性高血糖合并偏侧舞蹈症1例及影像学表现

<正>1临床资料患者,男,66岁,因"右侧肢体乏力、不自主活动4 d"入院。既往糖尿病史6年,服用格列美脲1片、1次/d和二甲双胍片1片、3次/d治疗,自行停药3月。专科检查:右侧肢体不自主活动,呈舞蹈样,肌力4级,肌张力稍增高;左侧肢体肌力5级,肌张力正常,余未见异常。辅助检查:随机血糖:40.15 mmol/L,空腹血     

老年非酮症性高血糖合并偏侧舞蹈症10例临床分析

目的 探讨非酮症性高血糖合并偏侧舞蹈症(HC-NH)的临床表现、发病机制以及影像学改变特点.方法 我院自2000年6月至2009年6月收治非酮症性高血糖合并偏侧舞蹈症10例,对该组患者的临床资料进行分析,总结其临床特点、发病机制以及影像学改变特点.结果 该组患者均为老年人,急性或亚急性发病,发病时血糖水平16.3～27.5 mmol/L,检测尿酮体多为阴性.舞蹈样症状累及患者的单侧或双侧肢体或面部.CT显示为病灶对侧的尾状核头与壳核早期呈高密度,短时间内可消失;MRI于T1呈高信号,T2呈稍低信号,病灶部位区域中心呈混杂信号而周边高信号.结论 HC-NH的MRI表现为T1纹状体高信号,可能构成偏侧舞蹈症临床综合征.影像学改变可能表明由代谢紊乱引起的斑片状脑出血,采用氯丙嗪、氟哌啶醇治疗疗效较好.     

非酮症高血糖合并偏身舞蹈症1例

偏身舞蹈症系局限于一侧上下肢及面部迅速、不规则、不自主的舞蹈样动作.通常由于对侧丘脑底核、基底核损伤引起,常见于急性脑血管病变,可由代谢性疾病、肿瘤、神经变性疾病、免疫性疾病、药物和毒物引起,临床上比较少见.我科收治了1例该病患者,报告如下.     

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餐后血糖升高而空腹血糖正常,即糖耐量减低 (im pairedglucosetolerance,IGT),通常伴随着血胰岛素水平的升高及胰岛素抵抗,其心血管疾病的发生率亦较正常人明显增高。越来越多的证据表明,无论是非糖尿病性餐后高血糖还是胰岛素抵抗或是心血管疾病,均具有一个共同的致病机制,即氧化应激紊乱。氧化应激主要由反应性氧产物 (reactiveoxygenspe cies,ROS)介导,包括过氧化氢H2O2、超氧阴离子O-2 ·、羟基·OH等。近年来的研究提示ROS作为极其重要的细胞内信使,可以活化几乎所有己知的信号传导通道。高糖状态下线粒体电子传递链产生过多…     

Persistent hemichorea associated with thyrotoxicosis.

We describe a case with unilateral chorea associated with thyrotoxicosis. A 23-year-old female with no family history of neurological diseases acutely developed choreic movements of the left extremities during gross thyrotoxicosis. CT scan and MRI study demonstrated no abnormality. Single-photon emission CT with technetium Tc 99m-labeled hexamethylpropyleneamine oxime revealed normal cerebral perfusion. Although the choreic movements were partially improved by dopamine antagonist, they persisted for two months until successful treatment of the thyrotoxicosis finally abolished these movements. Increased sensitivity of dopamine receptors may be responsible for persistent choreic movements in thyrotoxicosis.     

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众所周知,高血糖状态对机体的主要影响是产生急性氧化应激作用;使胰岛素合成减少,胰岛素出胞障碍;高渗糖液使血容量增加,心脏负荷加重;糖的渗透性利尿可直接损害肾小管上皮细胞;糖进入肝脏,脂肪与氨基酸代谢障碍,体内的成糖成酯过多,使肝的解毒作用下降;致细胞免疫功能下降     

Evaluation of transient hyperglycemia in non-diabetic patients with febrile neutropenia

BackgroundWe aimed to examine the effect of transient hyperglycemia in non-diabetic patients with febrile neutropenia.MethodsA total of 86 patients with febrile neutropenia were evaluated between June 2006 and December 2009. After measuring random blood glucose level at admission, cases with stress hyperglycemia were included in the study. Stress hyperglycemia was defined as documented random blood glucose level of 140 mg/dl and above without known diabetes mellitus, impaired glucose tolerance and impaired fasting glucose. A Multinational Association for Supportive Care in Cancer (MASCC) scoring system was used for the prediction of low and high risk patients according to medical complications at the onset of the febrile episode.ResultsThere were more patients with stress hyperglycemia than the patients with normoglycemia in the high risk group (p = 0.001). The growth of gram negative bacteria and fungi was higher in patients with stress hyperglycemia than with normoglycemia (p = 0.001). The patients receiving antifungal therapy had a higher rate of stress hyperglycemia than the patients without receiving antifungal therapy (p = 0.009). The patients with stress hyperglycemia had higher mortality rates than the patients with normoglycemia (p = 0.007). According to the MASCC risk-index, stress hyperglycemia increased 3.35 fold in the high risk patients compared to the low risk patients (p = 0.046) and 4.14 fold in the patients treated with antibacterial and antifungal agents compared to the patients treated with only antibacterial agents (p = 0.038).ConclusionPatients with stress hyperglycemia had more adverse clinical outcomes than patients with normoglycemia. We think further studies are needed to evaluate the relationship between stress hyperglycemia and febrile neutropenia.     

糖尿病性偏侧舞蹈症3例临床分析

目的探讨糖尿病性偏侧舞蹈症的临床表现、发病机制及特殊的影像学变化。方法分析了3例糖尿病性偏侧舞蹈症患者的临床症状、影像变化及治疗经过,并复习相关文献。结果3例均为未经治疗的糖尿病患者,其中2例为糖尿病非酮症高血糖症,1例为酮症高血糖症。舞蹈样症状均为突发起病且以一侧肢体为主,清醒时出现,睡眠时消失。早期CT表现为舞蹈症状对侧的尾状核、壳核和(或)苍白球的高密度影像,并在1个月左右减弱或消失;磁共振(MRI)T1像为病灶部位的片状高信号,在持续数月后信号减低,T2则表现为多变信号,边界清晰,无水肿征象。结论糖尿病性偏侧舞蹈症多见于糖尿病控制不佳的高血糖症患者,糖尿病酮症及非酮症均可发病。病变部位以纹状体为主,其早期CT表现为高密度影,MRIT1像为高信号、T2像为多变信号。认识这种突发的舞蹈症状及影像变化有利于糖尿病高血糖症的早期诊断与治疗。     

Choreoathetosis associated with non-chetotic hyperglycemia

Choreoathetosis is a rare neurologic complication of the diabetic disease. The purpose of this case report is to increase the knowledge of such occurrence by describing the case of an elderly woman who was admitted to our institution for an over 20-day history of choreic movement in the left side of the body. She had a 6-year history of type 2 diabetes mellitus with a poor metabolic control including a glycosylated hemoglobin of 13%. Unenhanced computed tomography of the brain was negative. At magnetic resonance imaging, the right putamen showed high signal intensity on T1-weighted images and an area of high signal intensity on T2-weighted images, diffusion-weighted images and apparent diffusion coefficient maps. During the hospitalization, an adequate diet therapy was performed, and insulin therapy was gradually adjusted using regular insulin at main meals associated with basal insulin (glargine) ??bed time??. This resulted in progressive normalization of blood glucose values and an improvement of dyskinesia. There is a deep correlation between non-chetotic hyperglycemia and neurologic lesions leading to choreoathetosis. The etiopathogenesis seems multifactorial, and include hyperosmolar damage on cortical cells, alteration in GABA neurotransmission and in cerebral vascular self-regulation mechanism. Notably, in DM type 2 choreoathetosis may be related to both vascular and neuro-metabolic alterations in the basal nucleus due to inadequate glycemic control continuing in the time. This rare complication of DM type 2 is a pathological entity to be considered benign, since it is generally transient and reversible with the attainment of an adequate metabolic compensation.