Persistent hemiballism with striatal hyperintensity on T1-weighted MRI in a diabetic patient: a 6-year follow-up study

The combination of hemiballism, hyperglycemia and hyperintensity of the str iatum on T1-weighted MRI constitutes a unique syndrome. We report the follo w-up of a patient with this disorder whose hemiballism was sustained for ov er 5 years. High density on CT of the right striatum turned into normodensi ty in 4 months, and hyperintensity on T1-weighted MRI and hypointensity on T2-weighted MRI of the lesion were resolved in 18 months. A decreased perfu sion of the lesion by SPECT remained 37 months after onset. There was no vo lume change of the lesion during the course of the illness. The radiologica l features support the possible pathology of either or both petechial hemor rhage and astrocytosis with high protein concentration after ischemic insul t. The hemiballism may result from selective damage of GABA/enkephalin-cont aining neurons in the striatum and can persist without the primary histolog ical changes causing the striatal T1-hyperintensity in this disorder. (C) 1 999 Elsevier Science B.V. All rights reserved.