Neuroimaging Findings in Hypoglycemia Triggered Syndrome of Acute Bilateral Basal Ganglia Lesions in Patients Treated With Regular Dialysis: Two Case Reports

Abstract

The syndrome of bilateral basal ganglia lesions in diabetic uremic patients is a rare disorder with only few cases described in the literature, predominantly Asian patients. It has characteristic clinical and imaging features consisting of acute hyperkinetic or hypokinetic extrapyramidal disorder in association with uniform neuroimaging findings of bilateral symmetrical basal ganglia changes in diabetics undergoing hemodialysis. Its pathophysiology remains largely unknown. Uremic toxins, metabolic acidosis and diabetic microangiopathy are among the factors believed to contribute to its pathogenesis. Here we report two patients with uremia and diabetes, who developed the syndrome of acute bilateral basal ganglia lesions after an incidence of severe hypoglycemia. We would like to emphasize the importance of appropriate diagnose and management of the condition in uremic patients and also consider hypoglycemia as a candidate trigger factor.