Yokoi Katsunori, Kazuta Tomoyuki, Torii Ryouta, Endo Toshihiro, Araki Amane, Terao Shinichi
Department of Neurology, Kasugai City Hospital.
Rinsho Shinkeigaku. 2017 Oct 27;57(10):591-594. doi: 10.5692/clinicalneurol.cn-001041. Epub 2017 Sep 28.
We report the case of a 77-year-old woman with diabetic chorea, which presented as hemiballism of the right limbs. Initial blood examination revealed that sugar and hemoglobin A1c levels were 732 mg/dl and 12.2%, respectively. Thus, a diagnosis of hyperglycemic hyperosmolar syndrome was made at a previous hospital. Ballism of the right limbs developed after 10 days and progressively worsened. After a month, the patient was admitted to our hospital. Brain MRI (axial T-weighted imaging) revealed a high-signal-intensity area in the left striatum. Dopamine transporter SPECT demonstrated reduced I-ioflupane binding in the bilateral striatum with left side predominance. Although haloperidol and risperidone were ineffective for her involuntary movement, chlorpromazine had a little effect. Levodopa and gabapentin combination treatments were effective in decreasing the symptoms. It was considered that dopamine antagonist was the medical treatment for diabetic chorea and that levodopa could worsen neurological symptoms such as chorea-ballism. However, in our case, levodopa treatment was effective.
我们报告了一例77岁患有糖尿病性舞蹈症的女性病例，其表现为右肢偏身投掷症。初次血液检查显示血糖和糖化血红蛋白A1c水平分别为732 mg/dl和12.2%。因此，前一家医院诊断为高渗高血糖综合征。右肢投掷症在10天后出现并逐渐加重。一个月后，患者入住我院。脑部MRI（轴位T加权成像）显示左侧纹状体有高信号强度区域。多巴胺转运体SPECT显示双侧纹状体中I-碘氟烷结合减少，以左侧为主。尽管氟哌啶醇和利培酮对她的不自主运动无效，但氯丙嗪有一点效果。左旋多巴和加巴喷丁联合治疗在减轻症状方面有效。曾认为多巴胺拮抗剂是糖尿病性舞蹈症的治疗药物，且左旋多巴可能会加重舞蹈症 - 投掷症等神经症状。然而，在我们的病例中，左旋多巴治疗是有效的。
