A Case of the Syndrome of Acute Bilateral Basal Ganglia Lesions due to Hypoglycemia in Hemodialysis Patient

Patients with chronic kidney disease may have neurological complications including uremic encephalopathy, stroke, neuropathy and myopathy. Rarely, acute movement disorder associated with bilateral basal ganglia lesion is seen in patients with end stage kidney disease. The hallmarks of this condition include reversible and uniform lesions of the basal ganglia on MRI which stand for decreased signal intensity on T1-weighted images and increased signal intensity on T2-weighted images, and the clinical presentation includes acute parkinsonism and/or involuntary movements. This syndrome has been reported mainly in Asian patients, typically in the setting of long-standing diabetes. We report a case of bilateral basal ganglia lesions in a patient with chronic renal failure, poorly controlled diabetes, and incidents of severe hypoglycemia.
In our case, there was no evidence of acute metabolic disorders. Most reported patients with acute basal ganglia lesions in uremia also had diabetes and/or abnormal blood glucose levels. Our case had previously experienced occasional hypoglycemia before the onset of involuntary choreic movements. MRI of our patient showed acute bilateral basal ganglia lesion, corresponding to cytotoxic edema. This pattern was also observed in patients with hypoglycemic encephalopathy.