ĐẶC ĐIỂM LÂM SÀNG VÀ HÌNH ẢNH HỌC THẦN KINH CỦA BỆNH THỂ VÂN DO ĐÁI THÁO ĐƯỜNG: MỘT NGHIÊN CỨU HỒI CỨU 5 NĂM TẠI BỆNH VIỆN ĐẠI HỌC Y DƯỢC THÀNH PHỐ HỒ CHÍ MINH

Abstract

Background: Diabetic striatopathy (DS) is characterized by choreiform/ballistic movements and typical neuroimaging lesions in patients with diabetes mellitus. This is rare disease, so there have been no studies with a large enough sample size to analyze the clinical and neuroimaging features. Objective: To describe the clinical manifestations and neuroimaging features in the patients with diabetic striatopathy. Methods: This is a retrospective descriptive study of a total of 36 diabetic patients with clinical chorea/ballism and basal ganglia hyperintensity on brain MRI/CT with T1W sequence. Data were retrospectively collected from electronic medical records over 5 years (2018-2023) at the University Medical Center Ho Chi Minh City, Vietnam. Results: A total of 36 patients were included, with a mean age of 75,1 ± 11,6 years. The majority were elderly women, accounting for 83,3%. All patients had type 2 diabetes mellitus in which 16,67% were newly diagnosed. The average blood glucose concentration at the onset of movement disorders was 12,36 ± 7,57 mmol/L and HbA1c level was 11,25 ± 3,19%. Positive blood ketone was observed in 33,3% of cases. Brain MRI was performed in 32 patients, head CT was in 7, and 3 patients received both brain MRI and head CT. The characteristic findings of hyperintensity on T1W MRI and/or increased density on CT simultaneously in the globus pallidus and putamen were most common (53.1%). Clinically, two predominant movement disorders observed were chorea (72,2%) and ballism (27,78%). Hemichorea was the most common pattern (80,56%), followed by generalized chorea (19,44%) with facial involvement noted in 30,56% of cases. All patients have glycemia controlled. The most frequently prescribed antipsychotic was risperidone (66,67%), followed by haloperidol (33,33%) with a mean daily dosage of 3,139 ± 1,722 mg. 56.7% of the patients improved partially and 30% improved completely with choreiform symptoms. The average time to clinical improvement was 6,18 ± 7,1 days. Conclusion: Our study showed that clinical and neuroimaging features were typical in patients with diabetic striatopathy. Most choreiform symptoms improved partialy or completely after the treatment.