Chatterjee Subhankar, Ghosh Ritwik, Dubey Souvik
Post-doctoral trainee, Department of Endocrinology, Medical College & Hospital, Kolkata, India
Senior resident, Department of General Medicine, Burdwan Medical College & Hospital, Burdwan, West Bengal, India
Acute onset de novo movement disorders are increasingly being reported in the settings of hyperglycemia, particularly from Asian countries. Although hemichorea-hemiballism is the most common and classically described movement semiology in association with hyperglycemia, various other hyperkinetic (choreoathetosis, dystonia, tremors, akathisia, restless leg syndrome etc.) and hypokinetic (parkinsonism) movement disorders are recognized. Diabetic striatopathy (DS) is defined as the disease phenomenon characterized by either choreo-ballistic movement or suggestive signature changes in striatum on imaging or presence of both. DS is generally considered as the complication of long-standing, poorly controlled non-ketotic hyperglycemia with acute hyperglycemic surge, though it can also be the first presentation of previously undiagnosed diabetes. Thus, it is recommended to test for capillary blood glucose in every patient presenting with de novo acute onset movement disorders of any semiology irrespective of past history of diabetes. It is important to recognize that normal brain imaging does not exclude the diagnosis of DS (clinically isolated DS) because nearly 50% cases may not have any characteristic neuroradiological stigmata. There is also high prevalence of clinical-neuroradiological discordance in DS cases. Thus, while managing such patients’ priority should be imparted on bedside identification of the movement semiology accurately and aggressive treatment of hyperglycemia rather than ordering expensive neuroradiological investigation. Generally diabetic movement disorder carries excellent prognosis. The majority of cases rapidly resolves with insulin therapy alone with or without use of adjunctive neuroleptics. For complete coverage of all related areas of Endocrinology, please visit our on-line FREE web-text, WWW.ENDOTEXT.ORG.
急性起病的新发运动障碍在高血糖情况下的报道越来越多，尤其是来自亚洲国家。尽管偏侧舞蹈症-偏侧投掷症是与高血糖相关的最常见且经典描述的运动症状学，但也认识到了各种其他运动亢进（舞蹈手足徐动症、肌张力障碍、震颤、静坐不能、不宁腿综合征等）和运动减退（帕金森症）性运动障碍。糖尿病性纹状体病（DS）被定义为以舞蹈样-弹道样运动或影像学上纹状体的特征性改变或两者均存在为特征的疾病现象。DS通常被认为是长期、控制不佳的非酮症高血糖伴急性高血糖波动的并发症，尽管它也可能是先前未诊断糖尿病的首发表现。因此，建议对每一位出现任何症状学的新发急性起病运动障碍的患者进行毛细血管血糖检测，无论其既往糖尿病史如何。重要的是要认识到正常的脑部影像学检查并不能排除DS的诊断（临床孤立性DS），因为近50%的病例可能没有任何特征性的神经放射学特征。DS病例中临床-神经放射学不一致的发生率也很高。因此，在管理此类患者时，应优先准确地在床边识别运动症状学并积极治疗高血糖，而不是进行昂贵的神经放射学检查。一般来说，糖尿病性运动障碍预后良好。大多数病例仅通过胰岛素治疗，无论是否使用辅助性抗精神病药物，都能迅速缓解。如需全面涵盖内分泌学的所有相关领域，请访问我们的在线免费网络文本，网址为WWW.ENDOTEXT.ORG。
