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Acute movement disorder associated with reversible bilateral basal ganglia lesions is an increasingly recognized syndrome in patients with end-stage renal disease, especially in the setting of concurrent diabetes mellitus. We report an elderly man with end-stage diabetic nephropathy treated by daily automated peritoneal dialysis who developed subacute symptoms of gait disturbance, dysarthria, dysphagia and lethargy. Computed tomography and magnetic resonance imaging of the head revealed bilateral symmetrical basal ganglia lesions. Repeat imaging 3 weeks later showed that these lesions had regressed spontaneously. However, his neurological symptoms improved slowly. These findings were similar to 23 other cases in the literature. Review of these cases shows that clinical features were predominantly bradykinesia, gait disturbance and concurrent metabolic acidosis (observed in 90% of cases). The pathogenesis of this condition has not been clearly defined, but uraemia may be an aggravating factor in predisposed patients, particularly in the presence of diabetic microvascular disease. There is no specific treatment for this condition; supportive measures are the mainstay of management. In the majority of patients, neurological improvement lags behind regression of basal ganglia lesions seen with neuroimaging, and the long-term outcome is variable. |
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Asians
basal ganglia
basal ganglia,lesion of
basal ganglia,lesion,bilateral
bradykinesia
CAT scan,abnormal
deep gray nuclei
diabetes dialysis basal ganglia syndrome
diabetes mellitus
diabetes mellitus,neurologic manifestations of
dialysis
dysarthria
gait disorder
lenticular nucleus,lesion of
lenticular nucleus,lesion of,bilateral
metabolic acidosis
movement disorder
movement disorder,extrapyramidal
MRI,abnormal
MRI,disappearing lesion on
Parkinsonism syndrome
prognosis
renal failure
reversible neurologic disorder
review article
uremia
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