Neuro_MR_Brain: 59 M, sudden onset hemichorea, DM2.

MRI BRAIN WITH AND WITHOUT CONTRAST:

CLINICAL HISTORY: 59-year-old male with sudden onset of hemichorea and hemidystonia in January.

FINDINGS:

Parenchyma: T1 hyperintensity seen along the right globus pallidus and the right striatum along with T2 hyperintensity in the adjacent internal capsule. No enhancement is noted on postcontrast imaging and there is no restriction of diffusion. Susceptibility artifact is seen on GRE which may represent hemorrhage or mineralization/calcium deposition. The left basal ganglia are normal in appearance.

Confluent periventricular T2 hyperintensities also seen along the parietal lobes bilaterally which are more extensive than is typically seen with chronic small ischemic change.

Ventricles and extra-axial spaces: Appropriate for age.

Orbits: Normal.

Visualized paranasal sinuses: Clear.

Mastoid air cells: Clear.

Bones: Normal.

Additional comment: None.

IMPRESSION:

1. T1 hyperintensity seen along the right globus pallidus and the right caudate along with T2 hyperintensity in the adjacent internal capsule. Susceptibility is seen which may represent hemorrhage or mineralization/Manganese or other metal deposition. There is no enhancement or restriction of diffusion. In addition, there are confluent periventricular T2 hyperintensities along the parietal lobesleft slightly more than the right sidewhich are more extensive than is typically seen with small vessel chronic ischemic change. Given the patient's history of type 2 diabetes these findings are favored to represent nonketotic hyperglycemic hemichorea although the findings are typically described to be reversible. Less likely, this could represent sequelae of encephalitis, other metabolic disorders or ischemia. It would be useful to obtain the prior outside imaging to evaluate the change over time.

(Nonketotic hyperglycemic hemichorea)