Suzuki Tomohiro, Tetsuka Syuichi, Ogawa Tomoko, Hashimoto Ritsuo, Kato Hiroyuki
Department of Neurology, International University of Health and Welfare Hospital, Nasushiobara, Japan.
JMA J. 2022 Jan 17;5(1):141-145. doi: 10.31662/jmaj.2021-0101. Epub 2021 Dec 3.
The patient was a 57-year-old man with a 15-year history of diabetes mellitus and a 3-year history of dialysis. He developed a subacute onset of Parkinsonism, including gait disturbance, bradykinesia, cogwheel rigidity, and myoclonus attacks. Magnetic resonance imaging (MRI) of the brain revealed swollen bilateral basal ganglia lesions, which appeared hyperintense with the lentiform fork sign on fluid-attenuated inversion recovery images, indicating vasogenic edematous lesions. He was diagnosed with diabetic uremic syndrome. Dopamine transporter single-photon emission computed tomography revealed no decrease in dopamine transporters. After approximately 4 weeks of continuous hemodialysis, rehabilitation, and supportive therapy, his neurological symptoms and MRI findings markedly improved. Although this disease has been reported in a few cases, its etiology and treatment remain unclear. In this case of diabetic uremic syndrome, dopamine secretion capacity was normal even though the patient had parkinsonian symptoms. This finding might contribute to further elucidation of the pathological mechanism of diabetic uremic syndrome.
该患者为一名57岁男性，有15年糖尿病病史及3年透析史。他出现了帕金森综合征的亚急性发作，包括步态障碍、运动迟缓、齿轮样强直和肌阵挛发作。脑部磁共振成像（MRI）显示双侧基底节区病变肿胀，在液体衰减反转恢复序列图像上呈高信号，并伴有豆状核叉征，提示血管源性水肿性病变。他被诊断为糖尿病尿毒症综合征。多巴胺转运体单光子发射计算机断层扫描显示多巴胺转运体无减少。经过约4周的持续血液透析、康复治疗及支持治疗后，他的神经症状和MRI表现明显改善。尽管已有少数病例报道了这种疾病，但其病因和治疗仍不明确。在这例糖尿病尿毒症综合征患者中，尽管患者有帕金森症状，但多巴胺分泌能力正常。这一发现可能有助于进一步阐明糖尿病尿毒症综合征的病理机制。
