Hemicoréia-hemibalismo associado a hemorragia em gânglios da base em diabete mélito descompensado relato de dois casos

Cava, Paolo A. Di Remigio; Kowacs, Pedro André; Werneck, Lineu César

doi:10.1590/S0004-282X1996000300016

Resumos

Os autores apresentam dois casos de hemicoréia-hemibalismo de início súbito em pacientes portadoras de diabete mélito descompensado, cujas tomografias computadorizadas de crânio revelaram hemorragia difusa nos gânglios da base contralaterais aos movimentos anormais. A descrição de caso em paciente jovem e portadora de diabete mélito insulino-dependente é inédita. Os autores discutem os mecanismos fisiopatológicos que tentam explicar a relação entre a hiperglicemia não-cetótica e o quadro de hemicoréia-hemibalismo associado a lesão estrutural ao nível de núcleos da base.

coréia; balismo; diabetes mellitus

Two cases of acute onset hemichorea-hemiballism in female patients with complicated diabetes mellitus are described. Computerized tomography showed diffuse basal ganglia hemorrhage contralateral to the abnormal movements. Occurrence of such a presentation in a teenager with insulin-dependent diabetes mellitus is unique. The relationships between non-ketotic hyperglycemia, structural damage in the basal ganglia and movement disorders are reviewed.

chorea; ballism; diabetes mellitus

Hemicoréia-hemibalismo associado a hemorragia em gânglios da base em diabete mélito descompensado relato de dois casos

Hemichorea-hemiballism secondary to basal ganglia hemorrhage in complicated diabetes mellitus: report of two cases

Paolo A. Di Remigio Cava^I; Pedro André Kowacs^II; Lineu César Werneck^III

^IEspecialidade de Neurologia do Departamento de Clínica Médica, Hospital de Clínicas (HC), Universidade Federal do Paraná (UFPR). Médico Residente em Neurologia do HC-UFPR

^IIEspecialidade de Neurologia do Departamento de Clínica Médica, Hospital de Clínicas (HC), Universidade Federal do Paraná (UFPR). Médico Neurologista, Professor Substituto de Propedêutica Médica da UFPR

^IIIEspecialidade de Neurologia do Departamento de Clínica Médica, Hospital de Clínicas (HC), Universidade Federal do Paraná (UFPR). Professor Titular de Neurologia da UFPR

RESUMO

Os autores apresentam dois casos de hemicoréia-hemibalismo de início súbito em pacientes portadoras de diabete mélito descompensado, cujas tomografias computadorizadas de crânio revelaram hemorragia difusa nos gânglios da base contralaterais aos movimentos anormais. A descrição de caso em paciente jovem e portadora de diabete mélito insulino-dependente é inédita. Os autores discutem os mecanismos fisiopatológicos que tentam explicar a relação entre a hiperglicemia não-cetótica e o quadro de hemicoréia-hemibalismo associado a lesão estrutural ao nível de núcleos da base.

Palavras-chave:coréia, balismo, diabetes mellitus.

ABSTRACT

Two cases of acute onset hemichorea-hemiballism in female patients with complicated diabetes mellitus are described. Computerized tomography showed diffuse basal ganglia hemorrhage contralateral to the abnormal movements. Occurrence of such a presentation in a teenager with insulin-dependent diabetes mellitus is unique. The relationships between non-ketotic hyperglycemia, structural damage in the basal ganglia and movement disorders are reviewed.

Key words: chorea, ballism, diabetes mellitus.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceito: 29-abril-1996.

Dr. Pedro André Kowacs - Disciplina de Neurologia, Hospital de Clínicas UFPR - Rua General Carneiro 181, 12° andar, sala 1236 - 80060-900 Curitiba PR - Brasil.

1. Abbot RD, Donahue RP, Mac Mahon SW, Reed DM, Yano K. Diabetes and the risk of stroke: The Honolulu Heart Program. JAMA 1987;257:949-952
2. Altafullah I, Pascual-Leone A, Duvall K. Putaminal hemorrhage accompanied by hemichorea-hemiballism. Stroke 1990;21:1093-1094.
3. Bedwell SF. Some observations on hemiballismus. Neurology 1960;10:619-622
4. Dewey RB, Jankovic J. Hemiballism-hemichorea: clinical and pharmacological findings in 21 patients. Arch Neurol 1989;46:862-867.
5. Dietzel J. Oxygen transport impairment in diabetes. Diabetes 1976; 25(Suppl 2):832-838.
6. Flora GC, Baker AB, Loewenson RB, Klassen AC. A comparative study of cerebral atherosclerosis in males in females. Circulation 1968;38:859-869.
7. Fuller JH, Keen H, Jarret RJ, Omer T, Meade TW, Chakrabarti, R, North WRS, Stirling Y. Haemostatic variables associated with diabetes and its complications. Br Med J 1979;2:964-966.
8. Haan T, Kremmer NPH, Padberg GWAM. Paroxysmal choreo-athetosis presenting symptoms of diabetes mellitus. J Neurol Neurosurg Psychiatry 1989-,52:133.
9. Jones R Jr, Baker R, Kott S. Hypertensive putaminal hemorrhage presenting with hemichorea. Stroke 1985;16:130-131.
10. Lin JJ, Chang MK. Hemiballism-hemichorea and non-ketotic hyperglycaemia. J Neurol Neurosurg Psychiatry 1994;57:748-750.
11. Rapoport SI, Fredericks WR, Ohno K, Pettigrew KD. Quantitative aspects of reversible osmotic opening of the blood-brain barrier. Am J Physiol 1980;238:421 -431.
12. Rector GW, Herlong HF, Moses H. Nonketotic hyperglycemia appearing as choreoathetosis or ballism. Arch Intern Med 1982;142:154-155.
13. Sanfield JA, Finkel J, Lewis S, Rosen SG. Alternating choreoathetosis associated with uncontrolled diabetes mellitus and basal ganglia calcification. Diabetes Care 1986;9:100-101.
14. Tortoritis M, Cornish P, Thompson F. Nonketotic hyperglycemia. Arch Intern Med 1982,142:1045.

Datas de Publicação

Publicação nesta coleção
10 Nov 2010
Data do Fascículo
Set 1996

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Abbot RD, Donahue RP, Mac Mahon SW, Reed DM, Yano K. Diabetes and the risk of stroke: The Honolulu Heart Program. JAMA 1987;257:949-952

[2] 2. Altafullah I, Pascual-Leone A, Duvall K. Putaminal hemorrhage accompanied by hemichorea-hemiballism. Stroke 1990;21:1093-1094.

[3] 3. Bedwell SF. Some observations on hemiballismus. Neurology 1960;10:619-622

[4] 4. Dewey RB, Jankovic J. Hemiballism-hemichorea: clinical and pharmacological findings in 21 patients. Arch Neurol 1989;46:862-867.

[5] 5. Dietzel J. Oxygen transport impairment in diabetes. Diabetes 1976; 25(Suppl 2):832-838.

[6] 6. Flora GC, Baker AB, Loewenson RB, Klassen AC. A comparative study of cerebral atherosclerosis in males in females. Circulation 1968;38:859-869.

[7] 7. Fuller JH, Keen H, Jarret RJ, Omer T, Meade TW, Chakrabarti, R, North WRS, Stirling Y. Haemostatic variables associated with diabetes and its complications. Br Med J 1979;2:964-966.

[8] 8. Haan T, Kremmer NPH, Padberg GWAM. Paroxysmal choreo-athetosis presenting symptoms of diabetes mellitus. J Neurol Neurosurg Psychiatry 1989-,52:133.

[9] 9. Jones R Jr, Baker R, Kott S. Hypertensive putaminal hemorrhage presenting with hemichorea. Stroke 1985;16:130-131.

[10] 10. Lin JJ, Chang MK. Hemiballism-hemichorea and non-ketotic hyperglycaemia. J Neurol Neurosurg Psychiatry 1994;57:748-750.

[11] 11. Rapoport SI, Fredericks WR, Ohno K, Pettigrew KD. Quantitative aspects of reversible osmotic opening of the blood-brain barrier. Am J Physiol 1980;238:421 -431.

[12] 12. Rector GW, Herlong HF, Moses H. Nonketotic hyperglycemia appearing as choreoathetosis or ballism. Arch Intern Med 1982;142:154-155.

[13] 13. Sanfield JA, Finkel J, Lewis S, Rosen SG. Alternating choreoathetosis associated with uncontrolled diabetes mellitus and basal ganglia calcification. Diabetes Care 1986;9:100-101.

[14] 14. Tortoritis M, Cornish P, Thompson F. Nonketotic hyperglycemia. Arch Intern Med 1982,142:1045.