インスリン導入後の比較的急速な血糖改善に伴って発症し,長期にわたりフォローアップした糖尿病性舞踏病の1例  [in Japanese] A Case of Diabetic Chorea after the Relatively Rapid Improvement of Glycemic Control by Insulin Injection, and the Long-term Follow-up of the Patient's Condition  [in Japanese]

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Abstract

症例は68歳男性.65歳時に2型糖尿病と診断され内服治療中であった.68歳時に随時血糖596 mg/d<i>l</i>, HbA1c 14.4 %を認め,入院しインスリンを導入した.混合型製剤1日2回投与にて血糖は安定し退院となるも,導入1ヶ月後より右上下肢の舞踏病様不随意運動が出現.頭部MRIでは左被殻T1強調画像で高信号域を認め,糖尿病性舞踏病と診断した.ハロペリドール2.25 mg/日を開始し,5日で不随意運動は消失した.その後の経過は良好で10ヶ月後にハロペリドールを中止したが再発を認めず.MRIの病変は発症後5ヶ月後には消失.その後も7年間の長期的なフォローアップを行っているが,臨床症状,MRI所見ともに再発を認めず.一般に糖尿病性舞踏病は高血糖に伴って発症する.本例のように比較的急速な血糖改善に伴って発症することは報告が少ないうえ,発病から7年間再発を認めず,5年半後の画像検査を確認した貴重な症例であると考え報告する.

The patient was a 68 year-old man with a 3-year history of type 2 diabetes mellitus who took an oral hypoglycemic agent. He was admitted to our hospital for the initiation of insulin injections because his laboratory data showed a plasma glucose level of 596 mg/d<i>l</i> and an HbA1c level of 14.4 %. The patient's plasma glucose level decreased after the initiation of premixed insulin and he was discharged. A month after the initiation of insulin injections, he developed chorea in the right extremities. A T1-weighted brain MRI detected abnormal high intensity areas in the left putamen. He was diagnosed with diabetic chorea because the MRI findings were consistent with diabetic chorea. The administration of haloperidol 2.25 mg/day was initiated and his symptoms resolved after three days. Haloperidol treatment was discontinued ten months after the improvement of symptoms. The abnormal MRI findings disappeared in a follow up examination after five months after the occurrence of chorea. There was no recurrence of chorea or abnormal MRI findings for seven years. In general, diabetic chorea develops in connection with hyperglycemia. In the present case, however, diabetic chorea was diagnosed during the rapid improvement of the patient's plasma glucose level.

Journal

  • Journal of the Japan Diabetes Society

    Journal of the Japan Diabetes Society 58(6), 413-418, 2015

    THE JAPAN DIABETES SOCIETY

Codes

  • NII Article ID (NAID)
    130005087452
  • NII NACSIS-CAT ID (NCID)
    AN00166576
  • Text Lang
    JPN
  • ISSN
    0021-437X
  • NDL Article ID
    026599122
  • NDL Call No.
    Z19-401
  • Data Source
    NDL  J-STAGE 
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