Contralateral Basal Ganglia Research Articles

Non-ketotic hyperglycemia-induced hemichorea-hemiballism – A case presentation and literature review

Non-ketotic hyperglycemia-induced hemichorea-hemiballism (NKHHH) is an infrequent hyperkinetic movement disorder, also known as diabetic striatopathy or Chorea hyperglycemia basal ganglia syndrome (C-H-BG), characterized by repetitive, uncontrollable movements in the unilateral or bilateral limbs. An insult to the contralateral basal ganglia causes NKHHH to develop. NKHHH is caused by ischemia, followed by non-ketotic hyperglycemia and poorly controlled diabetes. NKHHH is a rare condition with a unique cause that only affects one side of the corpus striatum (caudate nucleus and putamen). Clinical events of hemichorea-hemiballism, laboratory tests (elevated blood glucose and hemoglobin A1c levels), and imaging modalities (computed tomography and magnetic resonance imaging) all contribute to diagnosing NKHHH. The objective of this case report is to represent cross-sectional imaging findings in a 55-year-old female who presented with hemichorea-hemiballism following non-ketotic hyperglycemia. In conclusion, the clinical manifestation of NKHHH and its computed tomography (CT) and magnetic resonance imaging (MRI) findings are crucial in determining the appropriate management.

Midline invasion predicts poor prognosis in diffuse hemispheric glioma, H3 G34-mutant: an individual participant data review

IntroductionDiffuse hemispheric glioma, H3 G34-mutant (DHGs), is a newly categorized tumor in pediatric-type diffuse high-grade gliomas, World Health Organization grade 4, with a poor prognosis. Although prognostic factors associated with genetic abnormalities have been reported, few reports have examined the clinical presentation of DHGs, especially from the viewpoint of imaging findings. In this study, we investigated the relationship between clinical factors, including imaging findings, and prognosis in patients with DHGs.MethodsWe searched Medline through the PubMed database using two search terms: “G34” and “glioma”, between 1 April 2012 and 1 July 2023. We retrieved articles that described imaging findings and overall survival (OS), and added one DHG case from our institution. We defined midline invasion (MI) as invasion to the contralateral cerebrum, brainstem, corpus callosum, thalamus, and basal ganglia on magnetic resonance imaging. The primary outcome was 12-month survival, estimated using Kaplan–Meier curves and logistic regression.ResultsA total of 96 patients were included in this study. The median age was 22 years, and the proportion of male patients was 48.4%. Lesions were most frequently located in the frontal lobe (52.6%). MI was positive in 39.6% of all patients. The median OS was 14.4 months. Univariate logistic regression analysis revealed that OS was significantly worse in the MI-positive group compared with the MI-negative group. Multivariate logistic regression analysis revealed that MI was an independent prognostic factor in DHGs.ConclusionsIn this study, MI-positive cases had a worse prognosis compared with MI-negative cases.Previous presentationsNo portion of this study has been presented or published previously.

Sleep and perivascular disruption: An illustrative case of severe sleep apnea, an enlarged Virchow-Robin space, and contralateral asymmetric periodic limb movements

Virchow-Robin spaces (VRS) are perivascular spaces that have been associated with impaired glymphatic function, poor sleep quality and sleep disorders. These spaces are also associated with neurological impairment. We report a case of a young adult male who presented with severe untreated sleep apnea, shift-work disorder, and excessive asymmetric periodic limb movements disorder in association with a prominent radiologically-identified VRS in the contralateral basal ganglia. This case illustrates the complex “chicken and egg” association between impaired sleep, the development of VRS, and subsequent sleep disorder most likely attributable to the development of this perivascular abnormality.

B - 70 Left-Sided Motor Symptoms in Parkinson's Disease Are Associated with Impaired Social Cognition: a Preliminary Study.

Disruption of frontostriatal pathways underlies working memory and executive function impairments in Parkinson's disease (PD), including theory of mind (ToM). PD symptoms appear on one side and remain lateralized, suggesting greater dysfunction in the contralateral basal ganglia. Previous studies have suggested the right hemisphere, particularly right frontal lobe, has greater involvement in ToM processing. We hypothesized PD subjects with left hemi-motor symptoms, indicating right hemisphere involvement, would show greater deficits on a ToM task. Fourteen PD subjects with lateralized symptoms (9 left, 5 right) and 12 controls were selected from an ongoing NIH-funded study. Participants were right-handed and free of other neurological conditions. Groups did not differ on age, education or sex. Participants completed a ToM story task, neuropsychological measures (Visual-Verbal test, verbal and design fluency, and digit span) and a depression scale. Relative to controls, PD subjects with left-sided symptoms had trouble deciding if the character was lying or joking (p = 0.001 95% CI[1.002, 4.277]) and trending difficulty discerning a character's second order belief (what another character was thinking) when the intent was humorous (p = 0.077; 95% CI[-0.122, 3.055]), after accounting for age. ToM story performance correlated with cognitive measures in PD subjects with right-sided symptoms, but not in those with left-sided symptoms or controls. Individuals with PD and demonstrating left hemi-motor symptoms may have greater difficulty in social cognition beyond executive function or working memory disorders, impacting interactions with caregivers and their quality of life. Investigation with a larger sample is needed to confirm these findings.

Striatal Hyperintensity in Non-Ketotic Hyperglycemia Induced Hemichorea-Hemiballismus Syndrome: Case Report

Introduction: Hemichorea-Hemiballismus (HC-HB) is usually associated with lesions in the contralateral basal ganglia of the central nervous system and can be caused by infection, neurodegeneration, oncological cases, stroke, and metabolic disorders. HC-HB disorders associated with non-ketotic hyperglycemia are rare and are characterized by involuntary and arrhythmic unilateral movements. This occurrence is more common in cases of women, the elderly and poor control of blood sugar levels. Case Report: A female patient 46 years old, came with complaints of uncontrolled movements in the right half of the body since July 2021. Then it spread to the legs also 1 month later. Prior to this complaint, it was triggered by a stressor. History of non-routine use of drugs. On general physical examination and vital signs within normal limits. Neurological examination found right hemichorea with arrhythmic characteristics, 1-5 Hz, medium-large amplitude, stereotypy, right arm and leg, suppressibility (+), worsens when stressed. A CT-Scan of the head without contrast showed no abnormalities, but an MRI revealed a non-ketotic hyperglycemic image. The patient then received haloperidol 0.75 mg orally every 12 hours and clobazam 5 mg every 12 hours orally and insulin therapy. Discussion: In this case report, it was found that female patients was poor in control her blood glucose and causing complications. This condition also known as diabetic striatopathy (DS). Several mechanisms to explain the pathogenesis of DS include metabolic disorders, ischemic injury resulting in ion deposition, hemorrhagic injury, dopaminergic and estrogenic imbalances, autoimmune inflammatory responses, and neurodegeneration. This is supported by MRI imaging that supports the presence of hyperintense on T1. Keywords: Hyperglycemia, Involuntary Movement, Striatopathy

Scalp acupuncture regulates functional connectivity of cerebral hemispheres in patients with hemiplegia after stroke.

Stroke is a common cause of acquired disability on a global scale. Patients with motor dysfunction after a stroke have a reduced quality of life and suffer from an economic burden. Scalp acupuncture has been proven to be an effective treatment for motor recovery after a stroke. However, the neural mechanism of scalp acupuncture for motor function recovery remains to be researched. This study aimed to investigate functional connectivity (FC) changes in region of interest (ROI) and other brain regions to interpret the neural mechanism of scalp acupuncture. Twenty-one patients were included and randomly divided into patient control (PCs) and scalp acupuncture (SAs) groups with left hemiplegia due to ischemic stroke, and we also selected 20 matched healthy controls (HCs). The PCs were treated with conventional Western medicine, while the SAs were treated with scalp acupuncture (acupuncture at the right anterior oblique line of vertex temporal). All subjects received whole-brain resting-state functional magnetic resonance imaging (rs-fMRI) scan before treatment, and the patients received a second scan after 14 days of treatment. We use the National Institutes of Health Stroke Scale (NIHSS) scores and the analyses of resting-state functional connectivity (RSFC) as the observational indicators. The contralateral and ipsilateral cortex of hemiplegic patients with cerebral infarction were associated with an abnormal increase and decrease in basal internode function. An abnormal increase in functional connectivity mainly exists in the ipsilateral hemisphere between the cortex and basal ganglia and reduces the abnormal functional connectivity in the cortex and contralateral basal ganglia. Increased RSFC was observed in the bilateral BA6 area and bilateral basal ganglia and the connectivity between bilateral basal ganglia nuclei improved. However, the RSFC of the conventional treatment group only improved in the unilateral basal ganglia and contralateral BA6 area. The RSFC in the left middle frontal gyrus, superior temporal gyrus, precuneus, and other healthy brain regions were enhanced in SAs after treatment. The changes in functional connectivity between the cerebral cortex and basal ganglia in patients with cerebral infarction showed a weakening of the bilateral hemispheres and the enhancement of the connections between the hemispheres. Scalp acupuncture has the function of bidirectional regulation, which makes the unbalanced abnormal brain function state restore balance.

Nonketotic Hyperglycemic Hemichorea in an Elderly Male: A Case Report

BackgroundNonketotic hyperglycemic hemichorea is a rare complication of diabetes mellitus seen in the emergency department. It is most commonly reported in elderly women, predominantly of Asian race, with poorly controlled diabetes mellitus. Patients present with a triad of nonketotic hyperglycemia, hemichorea, and contralateral basal ganglia abnormality on imaging. Its exact pathophysiology is still not known. However, it has a very good prognosis with early diagnosis and treatment. Case ReportWe report a case of hemichorea involving the right upper and lower limbs due to nonketotic hyperglycemia. The patient's symptoms resolved after normalization of blood glucose. Why Should an Emergency Physician Be Aware of This?Nonketotic hyperglycemic hemichorea should be included in the differential of a patient presenting with chorea and high blood glucose levels. It has an excellent prognosis with both symptoms and imaging abnormalities typically resolving completely with restoration of normoglycemia.

ODP261 Non-Ketotic Hyperosmolar Hyperglycemia Induced Hemichorea-Dystonia Syndrome, Without Radiologic Striatopathy

Abstract Background Movement disorder is an uncommon complication of Hyperglycemic crisis. It is often associated with diabetic striatopathy which is a clinico-radiologic entity that is associated with acute changes of the contralateral basal ganglia. Isolated dyskinetic-dystonic disorder without obvious radiologic lesion is a rare clinical entity. Case Report A 42-years-old woman with a history of type 2 diabetes mellitus was admitted with a 1-week history of involuntary right arm and face movements and 3 weeks of polyuria. She had recurrent choreiform right arm movements without athetosis or hemiballismus lasting about 2. Additionally, she experiences right cervicofacial dystonia. There was no involvement of the lower extremities, no loss of consciousness and no other neurologic deficit between attacks. Physical examination was essentially unveiling with no focal neurologic deficits or tremors. Initial work up showed elevated; blood glucose to 620mg/dl (65–110), serum sodium of 148mEq/L (135–145) and serum osmolality of 330mmol/kg (275–295). Work up was negative for acidosis, with pH of 7.39 (7.32–7.42), bicarbonate of 23mEq/L (23–31) and no ketones on urinalysis. Other relevant test including serum bilirubin, transaminases, ammonia level, calcium, ceruloplasmin and cupper were normal. An initial non-contrast CT scan of the brain was negative for acute pathology and MRI did not show any lesions in basal ganglia. E. E. G was also normal. Movements recurred twice in hospital, and she received IV lorazepam without much response. She was diagnosed with non-Ketotic hyperosmolar hyperglycemic chorea- dystonia syndrome. She received IV normal saline and started on insulin therapy resulting in improvement in serum glucose to 255 by the next morning. She was discharge after 72 hours with no recurrence at 2 weeks follow up visit. Discussion Hyperglycemic crisis may rarely be associated with dyskinetic syndromes, often due to the development of diabetic striatopathy and about 80% are without ketosis. The mechanism is believed to be due to impaired GABA synthesis in the basal ganglia. Prevalence of hyperglycemia induced striatopathy stands at 1 per 100,000. The commonest manifestation is that of hemiballismus and chorea. Very few cases of dystonia have been reported. It is a clinico-radiologic diagnosis with basal ganglia abnormalities on imaging stemming from edema, microhemorrhages or calcific changes. There are very few case reports of hyperglycemic dyskinetic syndromes without CNS changes on MRI. The average time for resolution of MRI changes is 60 days thus we believe our patient had no radiologic striatopathy. In majority of cases, resolution of hyperglycemia leads to clinical resolution of dyskinetic spells. Occasionally, some patients may require medications such as antipsychotics including haloperidol, or benzodiazepines such as clonazepam to control movements. In conclusion, movement disorder related to hyperglycemia though rare, can be disabling. Prognosis is excellent if a timely clinical diagnosis is made. Presentation: No date and time listed

Diabetic Striatopathy

Diabetic striatopathy is a rare clinico-radiological phenomenon characterized by hemichorea/hemiballismus, hyperglycemia, hyperosmolarity in the absence of ketoacidosis. It is due to lesion in contralateral basal ganglia which is evident as T1 hyperintensity in MRI brain study. Here we are reporting a case of hemichorea /hemiballismus which was associated with hyperglycemia. Our patient improved significantly once blood glucose was controlled adequately. As it carries good prognosis, we are reporting this rare case to illustrate the importance of recognition of this rare syndrome.

Hemichorea-hemiballismus as a rare presentation of non-ketotic hyperglycemia: a case report

Hemichorea-hemiballismus is a hyperkinetic movement disorder on one side of the body resulting from involvement of the contralateral basal ganglia and striatum mainly. A 50-year-old female presented with a 5-days history of choreiform movements affecting the left upper and lower limb along with hemiface. Her plasma glucose was 576 mgl/dl and her urinary ketones were negative suggesting non-ketotic hyperglycemia. Computed tomography revealed hyper-density in right caudate and putamen consistent with diabetic striatopathy. Non-ketotic hyperglycemia is a rare cause of hemichorea-hemiballismus syndrome. Hemichorea-hemiballismus can be an unusual and rare presentation of diabetic elderly population especially females. Early diagnosis and treatment of hyperglycemia yields an excellent prognosis.

Non-Ketotic Hyperglycemia-Induced Hemichorea-Hemiballism, A Case Presentation

Hemiballism is a rare hyperkinetic movement disorder characterized by repetitive, uncontrolled movements unilateral /or bilateral extremities, develops as a result of insult to the contralateral basal ganglia. The leading source for this disorder is ischemia, followed by non-ketotic hyperglycemia with poorly controlled diabetes. Non-ketotic hyperglycemic induced hemichorea-hemiballism is an uncommon but unique etiology of unilateral neuro-parenchymal findings restricted to corpus striatum (caudate nucleus and putamen). Nonketotic hyperglycemia-induced hemichorea-hemiballism diagnosed by Cross-sectional imaging modalities (Computed tomography and Magnetic resonance imaging), Clinical results (hemichorea-hemiballism), Laboratory tests (elevated blood glucose and hemoglobin A1c levels).

HEMICHOREA-HEMIBALLISM IN VARIOUS CONDITIONS: SERIAL CASE REPORTS

Introduction: Hemichorea-hemiballism (HCHB) is an uncommon movement disorder involved unilateral extremities characterized by irregular, poorly patterned, a continual hyperkinetic involuntary movement disorder in the proximal or distal parts of the body. The acute development of HCHB depends on focal lesions on the contralateral basal ganglia and subthalamic nuclei. Various conditions such as cerebrovascular, neurodegenerative, neoplastic, immunologic, infectious, and metabolic diseases are known as secondary causes of HCHB. This paper aims to compare and discuss the HCHB in various etiologies. Case Reports: Here, we reported 5 cases of HCHB induced by non-ketotic hyperosmolar hyperglycemia (NKKH), thrombotic stroke, and toxoplasmosis cerebral. We compare the admission data, clinical course, imaging, treatment, and outcome of every case. Conclusion: Various hypotheses have been proposed to explain the pathophysiology of HCHB due to these conditions. Principally, the main management for these cases is to determine the etiology and correct the underlying disorder

Bone Fracture Enhanced Blood-Brain Barrier Breakdown in the Hippocampus and White Matter Damage of Stroke Mice.

Background: Tibia fracture (BF) before stroke shortly causes long-term post-stroke memory dysfunction in mice. The mechanism is unclear. We hypothesize that BF enhances neuroinflammation and blood brain barrier (BBB) breakdown in the hippocampus and white matter (WM) damage. Methods: Mice were assigned to groups: BF, stroke, BF+stroke (BF 6 h before stroke) and sham. BBB integrity was analyzed 3 days after the surgeries and WM injury was analyzed 3 days and 8 weeks after the surgeries. Results: Stroke and BF+stroke groups had more activated microglia/macrophages and lower levels of claudin-5 in the ipsilateral hippocampi than the BF group. BF+stroke group had the highest number microglia/macrophages and the lowest level of claudin-5 among all groups and had fewer pericytes than BF group. Stroke and BF+stroke groups had smaller WM areas in the ipsilateral basal ganglia than the sham group 8 weeks after the injuries. The BF+stroke group also had smaller WM areas in the ipsilateral than sham and BF groups 3 days after the injuries and in the contralateral basal ganglia than stroke and BF groups 8 weeks after the injuries. Conclusions: BF exacerbates neuroinflammation and BBB leakage in the hippocampus and WM damage in basal ganglia, which could contribute to the long-lasting memory dysfunction in BF+stroke mice.

SUN-684 The Dance of Diabetes

Nonketotic hyperglycemic chorea-ballism (NKHCB) is a rare movement disorder typically associated with uncontrolled type 2 diabetes. It is often the result of a focal lesion of the contralateral basal ganglia. Here we present a case of a patient who presented with hyperglycemic chorea as the initial manifestation of their diabetes. A 73 year old caucasian female with no known past medical history was brought to the emergency room with involuntary movements of the left face, arm and leg. These movements were sudden in onset and not suppressible. Her vitals were stable on arrival and exam was benign apart from choreiform movements of the left arm, left leg and left perioral muscles. Her labs were significant for a random blood glucose level of 418 mg/dl and HbA1c of 12%. As part of her workup she underwent a CT head which showed an asymmetric hyperdensity involving the right putamen. She underwent additional workup of chorea to exclude infection, vitamin deficiencies, heavy metal poisoning, electrolyte imbalances, liver dysfunction, all of which returned negative. She eventually underwent an MRI of the brain which showed symmetric, mildly bright T1 signal within both putamen suggestive of mild bilateral calcium deposition bilaterally. The patient was further evaluated by neurology who felt that her overall clinical presentation and imaging findings were consistent with a diagnosis of NKHCB. She was placed on an insulin regimen with significant improvement in blood glucose levels. Her symptoms resolved within two weeks as noted on outpatient follow up. NKHCB is a rare condition that manifests in the setting of uncontrolled nonketotic diabetes mellitus. The exact underlying pathophysiology of changes seen on imaging of patients with NKHCB is not fully understood. The diagnosis is based on typical clinical and radiological features including the presence of ballistic or choreiform movements in the setting of marked hyperglycemia and the absence of ketoacidosis. This case is unusual as her chorea was the presenting symptom of her diabetes which was previously undiagnosed. The characteristic radiological feature is a high signal intensity basal ganglia lesion on the T1-weighted brain MRI. The mainstay of treatment includes normalization of the blood glucose, although in some cases antipsychotic use has been described. In most cases, complete resolution of symptoms has been reported within 10 months. Given the excellent prognosis with management of blood glucose, non ketotic hyperglycemia is an important differential to consider in a patient presenting with chorea-hemiballismus.

Effect of acupuncture at the anterior oblique parietotemporal line on gray matter remodeling in patients with hemiplegia of cerebral infarction

To observe the intervention effect of acupuncture at the anterior oblique parietotemporal line on gray matter remodeling in patients with hemiplegia of cerebral infarction based on voxel-based morphology (VBM), and to reveal the advantages and central effect sites of scalp acupuncture for hemiplegia of cerebral infarction. A total of 18 patients with hemiplegia of cerebral infarction in the right basal ganglia and 18 healthy subjects were enrolled and T1 structural scan was performed. The patients were randomly divided into scalp acupuncture group and non-scalp acupuncture group, with 9 patients in each group. SPSS20.0 was used to analyze the degree of neurological deficit (NIHSS) before and after treatment, and SPM8 software package was used to compare the change in gray matter after treatment between the two groups, the difference in gray matter between patients and healthy subjects. After treatment, the scalp acupuncture group had a significant reduction in NIHSS (P<0.05), while the non-scalp acupuncture group had no significant change in NIHSS (P>0.05); the scalp acupuncture group had a significantly lower NIHSS than the non-scalp acupuncture group after treatment (P<0.05). Compared with the healthy subjects, the patients with cerebral infarction had a voxel increase of gray matter in the bilateral cerebellum; after 2 weeks of treatment, the scalp acupuncture group had a voxel increase of gray matter in the motor-related cortex (such as the cerebellum, the anterior cingulate, the basal nucleus, and the medial frontal gyrus) and some parts of the sensory cortex, while the non-scalp acupuncture group had a slight voxel increase of gray matter in few brain regions which were not associated with motor. After treatment, the scalp acupuncture group had a voxel increase in the brain regions of the basal ganglia, mainly the lenticular nucleus and the claustrum. Compared with the non-scalp acupuncture group after treatment, the scalp acupuncture group had a greater gray matter increase in the brain regions mainly in the bilateral cerebellar cortex. Acupuncture at the anterior oblique parietotemporal line can promote neurological function recovery in patients with hemiplegia, possibly by promoting gray matter remodeling in the motor centers of the extrapyramidal system (mainly the bilateral cerebellum and the contralateral basal ganglia) and some parts of the sensory cortex and inducing functional compensation in corresponding brain regions.

Comparison of Hemichorea-Hemiballism between Acute Stroke and Nonketotic-Hyperglycinemia in the Clinical Scenario: Report of a Rare Diabetic Complication

Diabetes mellitus is the major cause of retinopathy, nephropathy and neuropathy. Hyperglycemia is one of major major advised effect on diabetes mellitus. Hemichorea-hemiballism, a rare manifestation of nonketotic hyperglycemia, characterized by involuntary arrhythmic motions in one side of the body which results from focal lesions in the contralateral basal ganglia. Here, we present a 39-year-old woman with violent involuntary rapid and irregular movements of left limbs three days prior to emergency department. Nonketotic hyperglycemia related hemichorea-hemiballism had been confirmed by biochemistry examination and brain computed tomography (CT). Aggressive glucose control with insulin was administered. Her symptoms got improvement gradually after euglycemia two weeks later.

Motor asymmetry and neuromelanin imaging: Concordance in Parkinson's disease

BackgroundThe onset of motor symptoms in Parkinson's disease (PD) is characteristically asymmetric and correlates with dopaminergic deficit of contralateral basal ganglia. This study explored the concordance between motor asymmetry and changes of substantia nigra pars compacta (SNc) using neuromelanin-sensitive imaging. MethodsForty-four subjects with PD and fifteen healthy controls were included in this study. Clinical laterality (CL) was based on the motor sub scores of the Unified Parkinson's Disease Rating Scale-Part III. All subjects underwent neuromelanin-sensitive imaging and imaging laterality (IL) was based on the differences between contrast ratios of the right and left lateral SNc. Concordance was evaluated by correlating CL and IL. ResultsMotor asymmetry at disease onset was reported in 97.72% of subjects with PD, of which 65.90% reported right-sided onset. Forty-three subjects were right-handed and 68.18% reported onset of symptoms on dominant side. Right CL was observed in 59.09%, left CL in 40.90%, right IL in 11.36% and left IL in 88.63%. Concordance was established in 61.36%, majority of whom had a combination of right CL and left IL. In healthy controls, a significantly lower contrast ratio of the left lateral SNc was also noted. ConclusionsHandedness may correlate with motor asymmetry and left hemisphere may have a predilection for neurodegeneration. The finding of significant neuronal loss of left SNc in controls warrants further evaluation for better understanding of motor asymmetry in PD. Neuromelanin sensitive imaging can be a useful tool to study the relationship between motor asymmetry and nigrostriatal dysfunction.

SPECT perfusion changes during ictal automatisms with preserved responsiveness in patients with right temporal lobe epilepsy

Ictal automatism with preserved responsiveness (APR) has been reported, particularly in nondominant temporal lobe epilepsy (TLE), but its pathophysiology remains poorly understood. This study sought to investigate the relationship between APRs and increased cerebral blood flow (CBF) using ictal single photon emission computed tomography (SPECT) in TLE.Forty-seven subjects with right mesial TLE (15 with and 32 without APR) were enrolled. Patients with APR (APR+) were subdivided into four groups according to degree of responsiveness during seizures. Cerebral blood flow changes during these seizures were semiquantitatively assessed by subtraction ictal SPECT coregistered to MRI (SISCOM).Hyperperfusion in temporal regions did not vary significantly between the APR+ and APR− groups. Cerebral blood flow changes in the frontal area, insula, cingulum, and occipital area were also nonsignificant. However, hyperperfusion in the ipsilateral parietal areas was more frequent in the APR− group than in the APR+ group. Furthermore, hyperperfusion of the contralateral basal ganglia showed an inclination to be more common in the APR− group, but without statistical significance.The study suggested that the involvement of the parietal association cortex during seizure may play an important role in ictal loss of consciousness in TLE. Further studies will be needed to elucidate the pathophysiology of changes in consciousness during temporal lobe seizures.

The Dance-de-Diabetes A Rare Complication of Non Ketotic Hyperglycemia

Diabetes mellitus, its diagnosis, and treatment along with the management of complications particularly Diabetic Ketoacidosis and the ominous Hyperglycemic osmolar Non-Ketotic Coma are well acquainted with all Physicians and Internists. Hemiballismus is an aberrant movement disorder that is characterized by uncontrolled, random, large-amplitude movements of the limbs. It is usually caused by a vascular lesion that involves the contralateral subthalamic nucleus (STN).The authors present a case of Diabetes mellitus presenting de Novo with Non-Ketotic Hyperglycemia manifesting with hemiballismus. Their brain CT scan pictures showed non-enhancing hyperdensities in the contralateral basal ganglia, and the MRI showed hyperintensities on T1W image and hypo-intensities on the T2W image. The patient was managed with aggressive glycemic control with insulin infusion along with Dopamine ( D2 ) Receptor antagonist Tetrabenazine. This case illustrates the importance of considering movement disorders in the differential diagnosis of hyperglycemic emergencies and distinguishing it from other intracranial pathologies as prompt diagnosis and treatment of hyperglycemia has a favorable prognosis.

Abstract TP342: Early Erythrolysis in Hematoma After Experimental Hemorrhage

Background: Erythrolysis in the clot after intracerebral hemorrhage (ICH) and the release of hemoglobin causes brain injury but it is unclear when such lysis occurs. The present study examined early erythrolysis in rats. &gt;Methods: Male Sprague-Dawley, spontaneously hypertensive (SHR) and Wistar Kyoto (WKY) rats had an intracaudate injection of 100μl autologous blood or a needle insertion (sham). All rats had T2 and T2* MRI scanning and brains were used for histology and CD163 (a hemoglobin scavenger receptor) and DARPP-32 (a neuronal marker) immunohistochemistry. Results: There was marked heterogeneity within the hematoma on T2* MRI, with a hyper- or isointense core and a hypointense periphery at days 1 and 3. Hematoxylin and eosin staining in the same animals showed significant erythrolysis in the core with the formation of erythrocyte ghosts. While the periphery of hematoma had erythrocytes with normal profiles, the border of the periphery and the center displayed distorted erythrocytes and areas with ghost erythrocytes. The degree of erythrolysis was correlated with the severity of neuronal loss (marked by DARPP 32) after ICH (r = 0.791, n = 18, p &lt; 0.01). Perihematomal CD163 was increased by day 1 after ICH and may be involved in clearing hemoglobin caused by early hemolysis (303 ± 128 at day 1 and 453 ± 57 cells/mm 2 at day 3, p&lt;0.01). Only a few CD163 positive cells were observed in the ipsilateral basal ganglia of sham controls and in the contralateral basal ganglia of ICH rats. ICH resulted in more severe erythrolysis (e.g. 18.3 ± 4.5 vs. 8.1 ± 5.2 %, p&lt; 0.01 at day 1), neuronal loss (30.0 ± 5.6 vs. 14.1 ± 4.4 %, p&lt;0.05 at day 1), and CD 163 upregulation (p&lt; 0.05) in SHR than in WKY rats. Conclusion: T2*MRI detectable early erythrolysis occurred in the clot after ICH, and activated CD163. Hypertension is associated with enhanced erythrolysis in the hematoma and more brain injury.