Teaching NeuroImage: Reversible Symmetric Basal Ganglia Lesions in a Patient With Diabetes Undergoing Dialysis

Abstract

A 50-year-old woman with diabetes and renal disease on hemodialysis presented with 1 month of involuntary movements, dysarthria, and gait disturbance. Examination revealed bradykinesia, dystonia, and choreoathetosis. Brain MRI showed symmetric basal ganglia lesions (Figure 1). Basic metabolic panel was stable from baseline with normal bicarbonate but elevated creatinine, blood urea nitrogen, and glucose. Serum and CSF testing was otherwise unremarkable. Repeat MRI 3 months later showed spontaneous lesion regression (Figure 2); however, her symptoms persisted. Findings were attributed to a well-described, but poorly understood, syndrome of basal ganglia injury in diabetic uremic patients due to metabolic and vascular dysregulation.1,2