An autopsy case of diabetic hemodialysis patient with ischemic change in the basal ganglia associated with hyperglycemic coma

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  • 高血糖昏睡が遷延し脳ＭＲＩにて大脳基底核病変がみられた糖尿病血液透析患者の１剖検例
  • 症例報告 高血糖昏睡が遷延し脳MRIにて大脳基底核病変がみられた糖尿病血液透析患者の1剖検例
  • ショウレイ ホウコク コウケットウ コンスイ ガ センエンシ ノウ MRI ニテ ダイノウ キテイカク ビョウヘン ガ ミラレタ トウニョウビョウ ケツエキ トウセキ カンジャ ノ 1 ボウケンレイ

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Abstract

A 55-year-old man who had been undergoing hemodialysis at our hospital with diabetes mellitus and alcohol abuse was admitted with consciousness loss. Blood sugar on initial examination was 1,086 mg/dL, and computed tomography and magnetic resonance imaging (MRI) did not demonstrate any abnormalities. These findings indicated a diagnosis of hyperglycemic coma. Although treatment with insulin was immediately started, his consciousness level was not improved. MRI performed after eight weeks demonstrated hyperintense lesions in the bilateral basal ganglia on T1-weighted images. Two and half months after his admission, he suddenly died and the autopsy findings exhibited ischemic change in the bilateral basal ganglia. Recently, cases of hyperintense changes in basal ganglia on T1-weighted MRI have been reported in hyperglycemic diabetic patients with hemichorea-hemiballism. These cases were not associated with long-standing disturbance of consciousness, and the prognosis was excellent. The clinical course in our case may have been affected by alcohol abuse, renal anemia and hemodialysis, added to hyperglycemia.

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