case_images: PMC6886634_01
case_images: Unenhanced CT scans of the brain obtained with a 40-slice CT scanner Siemens (Germany). Multiplanar reconstruction (MPR), thickness 3 mm along the bicommissural plane directed through the basal ganglia. Baseline CT scans 26 days and 24 days before hemichorea-hemiballism onset. These images show bilateral striatal hyperdensity before chorea was present. CT scans 3 months later demonstrate resolution of the findings
case_images: 1257_Fig1.jpg
case_images: PMC6886634_01_1257_Fig1.jpg
case_images: f1-1257-1-9677-1-10-20191022
case_images: An emergent brain CT was negative for acute lesions and only former small chronic ischaemic lesions were reported (Fig. 1, -26 days). Later review showed mild bilateral hypodensity of the striata was already present, which became clearer on another CT scan performed 2 days later (Fig. 1, -24 days). Striatal hyperdensity on CT scans was no longer detectable after about 3 months (Fig. 1).
case_images: Brain MRI scans performed 9 days after chorea onset show increased T1 signal intensity in both striata on axial T1-weighted imaging, particularly on the right side (upper panel). MRI scans performed 10 months later demonstrate resolution of the findings. However, the same region remained hypointense on susceptibility-weighted imaging (SWI) and gradient-echo sequences (T2*-GRE) (lower panel). The MRI scanner was a 1.5T Siemens Avanto (Germany)
case_images: 1257_Fig2.jpg
case_images: PMC6886634_01_1257_Fig2.jpg
case_images: f2-1257-1-9677-1-10-20191022
case_images: An emergent brain CT was negative for acute lesions and only former small chronic ischaemic lesions were reported (Fig. 1, -26 days). Later review showed mild bilateral hypodensity of the striata was already present, which became clearer on another CT scan performed 2 days later (Fig. 1, -24 days). The first brain MRI was performed 7 days after HCHB onset and confirmed an increase in signal intensity on axial T1-weighted imaging in both striata (Fig. 2). T1 MRI disappeared completely after 10 months, while striatal hypointensity on SWI and T2*-GRE still persisted 1.5 years later (Fig. 2). Table 1 shows the times and results of blood glucose and glycated haemoglobin tests and brain neuroimaging.
case_images: Video recorded 3 months after hemichorea-hemiballism onset during a follow-up visit. Involuntary movements in the left limbs were greatly reduced but still present, mostly when the patient was speaking. Involuntary movements were mainly choreoathetoid, affecting the distal part of the upper and lower limbs. Watch the video: https://youtu.be/xl4Tipdq2n4
case_images: 1257_Vid1.jpg
case_images: PMC6886634_01_1257_Vid1.jpg
case_images: f3-1257-1-9677-1-10-20191022
case_images: An emergent brain CT was negative for acute lesions and only former small chronic ischaemic lesions were reported (Fig. 1, -26 days). Later review showed mild bilateral hypodensity of the striata was already present, which became clearer on another CT scan performed 2 days later (Fig. 1, -24 days).