0:00

This is an axial T2-weighted image

0:02

of our 67-year-old with Huntington's chorea.

0:04

There are some tiny,

0:06

little bright areas in the basal ganglia,

0:08

and these represent nothing more than medial and

0:10

lateral MCA territory perforators.

0:14

But if you were to have areas of microhemorrhage

0:17

in the basal ganglia,

0:18

then you might start thinking about other disorders,

0:20

including vasculitis.

0:23

But if there's hyperglycemia,

0:25

then you might start thinking about some of the

0:27

metabolic causes with this cavitation

0:30

phenomenon of chorea.

0:33

Now, what are these metabolic causes?

0:35

Well, there's growing interest in the association of

0:37

chorea and nonketotic hyperglycemia

0:40

in type II diabetes mellitus.

0:42

This is interesting because patients who

0:44

are chronically ketotic, the ketones,

0:47

serve as food for the brain and are probably

0:51

preventative for certain neurodegenerative

0:53

disorders like Alzheimer's disease.

0:56

So, ketotic low-grade hyperglycemia

0:59

may be preventative for certain types of dementia,

1:03

but nonketotic hyperglycemia

1:05

and type II diabetes mellitus,

1:07

places the patient at risk for chorea,

1:11

especially if the patient is of Asian ethnic background.

1:15

And I've seen this

1:16

particularly in people of Filipino descent.

1:19

Now, if the patient presents with chorea

1:22

or chorea and ballism,

1:23

they usually are not obtunded.

1:26

They don't have loss of consciousness,

1:28

whereas the other subset of individuals

1:30

with non ketotic hyperglycemia

1:32

and severe ketotic hyperglycemia,

1:35

may have loss of consciousness.

1:37

The typical findings in patients with

1:39

hyperglycemia and this presentation of chorea

1:43

includes microhemorrhage

1:45

in the basal ganglia distribution.

1:47

Let's move on, shall we?