Putaminal petechial haemorrhage as the cause of chorea: a neuroimaging study
a Section of
Neurology, Veterans' General Hospital, Kaohsiung and
Department of Neurology at National Yang-Ming University, b Department of Medicine, c Department of
Radiology, Veterans' General Hospital, Kaohsiung, Taiwan
Correspondence to: Dr Ming-Hong Chang, Section of Neurology, Veterans' General Hospital-Kaohsiung, No 386, Ta-Chung 1st Road, Kaohsiung, Taiwan.
Received 11
November 1996 and in revised form 24 March 1997;
Accepted 27
March 1997
OBJECTIVES
A hyperintense putamen on either CT or
MRI as a finding associated with chorea has occasionally been described
and is almost always associated with non-ketotic hyperglycaemia. The
cause of the hyperintensity of the striatum in these images is still
controversial. Some reports have found that calcification was
responsible whereas others have advocated petechial haemorrhage as the
cause. The purpose of this study was to determine whether hyperintense
striata are caused by petechial haemorrhage or calcification, with the sequential imaging changes.
SUBJECTS AND METHODSFive patients presenting
with an acute onset of either hemichorea or generalised chorea and
showed either unilateral or bilateral hyperdense striatum on the
initial CT were assessed. Neuroimaging studies including sequential CT
and MRI examinations and detailed biochemical tests were performed.
RESULTSThree patients had pronounced
hyperglycaemia and the other two patients had no biochemical
abnormalities. In all patients, the first CT scans, performed within
two weeks of the onset of chorea, showed a high density over the
striatum contralateral to the chorea, which diminished or disappeared
two months later. T1 weighted imaging disclosed hypersignal intensities
over the striatum contralateral to the chorea on admission which
diminished two months later. T2 weighted imaging at two months showed
hyposignal intensity changes corresponding to the area with hypersignal
changes on T1 weighted images, implying haemosiderin deposition.
CONCLUSIONBased on the evolution of clinical
manifestations and the findings of neuroimaging, putaminal petechial
haemorrhage might be a new entity causing either hemichorea or
generalised chorea.
© 1997 by Journal of Neurology, Neurosurgery, and Psychiatry
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