Chorea and Broca aphasia induced by diabetic ketoacidosis in a type 1 diabetic patient diagnosed as Moyamoya disease

Watanabe, Chizuru; Oishi, Tetsuya; Yamamoto, Tunehiko; Sasaki, Kaori; Tosaka, Maki; Sato, Tosihiko; Kobayashi, Hiroko; Takayama, Shinichiro; Sato, Asako; Iwata, Makoto; Uchigata, Yasuko; Iwamoto, Yasuhiko

doi:10.1016/j.diabres.2004.04.005

« Previous Next »Diabetes Research and Clinical Practice
Volume 67, Issue 2 , Pages 180-185, February 2005

Chorea and Broca aphasia induced by diabetic ketoacidosis in a type 1 diabetic patient diagnosed as Moyamoya disease

Chizuru Watanabe
- Diabetes Center, Tokyo Woman’s Medical University, School of Medicine, 1-8 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
Tetsuya Oishi
- Diabetes Center, Tokyo Woman’s Medical University, School of Medicine, 1-8 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
Tunehiko Yamamoto
- Department of Internal Medicine, Osaka City General Hospital, Osaka, Japan
Kaori Sasaki
- Diabetes Center, Tokyo Woman’s Medical University, School of Medicine, 1-8 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
Maki Tosaka
- Diabetes Center, Tokyo Woman’s Medical University, School of Medicine, 1-8 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
Tosihiko Sato
- Department of Internal Medicine, Osaka City General Hospital, Osaka, Japan
Hiroko Kobayashi
- Diabetes Center, Tokyo Woman’s Medical University, School of Medicine, 1-8 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
Shinichiro Takayama
- Diabetes Center, Tokyo Woman’s Medical University, School of Medicine, 1-8 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
Asako Sato
- Diabetes Center, Tokyo Woman’s Medical University, School of Medicine, 1-8 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
Makoto Iwata
- Department of Neurology, Tokyo Women’s Medical University School of Medicine, Tokyo, Japan
Yasuko Uchigata
- Diabetes Center, Tokyo Woman’s Medical University, School of Medicine, 1-8 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
- Corresponding author. Tel.: +81-3-3353-8111; fax: +81-3-3358-1941.
Yasuhiko Iwamoto
- Diabetes Center, Tokyo Woman’s Medical University, School of Medicine, 1-8 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan

Received in revised form 12 April 2004; accepted 27 April 2004. published online 22 December 2004.

Abstract

We here report one case of hemichorea and Broca aphasia occurred with diabetic ketoacidosis. A 20-year-old woman with type 1 diabetes mellitus had experienced diabetic ketoacidosis fourth time after the onset of diabetes. At the third ketoacidotic episode, the patient was admitted to our hospital for the first time to show hemichorea of the left extremities. Brain computed tomography (CT) demonstrated a high-density area in the right caudate head and low-density area in the right putamen. Magnetic resonance angiography (MRA) demonstrated a stenosis at the root of the bilateral middle and anterior cerebral arteries. The hemichorea disappeared within 3 days. At the fourth ketoacidotic episode, not hemichorea but unconsciousness was there for 2 days even after ketoacidosis disappeared. After the unconscious state, Broca aphasia was demonstrated for 15 days. The cerebral angiography showed a finding compatible to Moyamoya disease. These findings support that chorea and Broca aphasia induced by diabetic ketoacidosis was developed in addition to blood vessel abnormalities such as Moyamoya disease. We suggest that poorly controlled diabetic patients with hemichorea should undergo cerebral angiography.

Keywords: Chorea, Broca aphasia, Diabetic ketoacidosis (DKA), Moyamoya disease