Hemichorea-hemiballism with striatal high signal intensity on T1-weighted images in diabetes

Hemichorea-hemiballsim has been reported as a rare Implication of nonketotic hyperglycemia. Recently, Some reports revealed that brain magnetic resonance images of nonketotic hyperglycemic patients with hemichorea-hemiballism showed characteristic contralateral striatal signal abnormality, We present six patients with hemichorea-heniiballism. All of them had diabetes mellitus and performed brain MR images. The MR images of them showed high signal intensity on Tl-weighted images and low signal intensity on T2 weighted images in the striatum contralateal to the involuntary movement. In general, the striatal high signal intensity on TI weighted images are presumed to have developed following hemorrhagic transformation, osmotic myelinolysis, or mild ischemia with reversible deposition of calcium or other material occurred in association with nonketotic hyperglycemia. However the precise mechanism of this signal change is not clear yet and needs pathological confirmation.

Subacute sclerosing panencephalitis presenting as young adult onset parkinsonism

Subacute sclerosing panencephalitis(SSPE) is a fatal chronic persistent encephalitis due to a sequela of measles virus infection. It is almost developed in childhood or school aged children. It's onset after the age of 20 is very rare. In addition, SSPE with prominent parkinsonian features is not common. We experienced a 26-year-old man with bradykinesia, slurred speech and gait disturbance for 1 month. He showed masked face, vertical and right horizontal conjugate gaze limitation, generalized hyperreflexia, rigidity, and myoclonic jerks. His gait was small-stepped festinatinog and propulsive with intermittent freeziong and ignition failure. He had a history of measles at his age of 13. Brain magnetic resonance images and all biochemistries including coper and ceruloplasmin level of serum were normla. Characteristic periodic synchronous discharges were noted on electroencephalogram. The antibody titer to measles virus was highly increased in serum and cerebrospinal fluid. Symptoms rapikly progressed to vegetative state and expired in 9.5 months after the initial symprom. Autopsy was performed. All parts of brain were moderately atrophied. In microscopic examination, diffuse glial and inflammatory changed with neuronal loss throughout the entire brain were noted. So we suggest that the possibility of SSPE may be considered as a cause of young adult onset parkinsonism.