Hyperglycemic Nonketotic Signal Changes of the Striatum: An Unusual Complication in the Setting of Neurosurgical Procedures.

Abstract

Hyperglycemic nonketotic chorea is an uncommon complication of poorly controlled diabetes mellitus. Patients typically develop abnormal signal changes in the striatum on imaging studies. Whereas the condition is well reported in the medical literature, reports on this topic in the surgical literature are lacking. We report the first case of striatal hyperglycemic nonketotic signal changes occurring in the setting of a frontotemporal craniotomy for resection of a sphenoid wing meningioma. Postoperative magnetic resonance imaging (MRI) of the patient demonstrated restricted diffusion within the bilateral caudate nuclei, globus pallidus, putamen, and thalami in response to intraoperative hyperglycemia. Normalization of the patient's serum glucose levels postoperatively was followed by improvement in the radiographic abnormalities and their associated clinical sequelae. At the patient's last follow-up appointment 5 months after surgery, MRI demonstrated complete resolution of the abnormal signal changes to the patient's neurologic baseline. Although uncommon, striatal signal changes associated with nonketotic hyperglycemia should be recognized as a potential complication of surgery. Knowledge of this rare entity is important so that tight control of perioperative serum glucose can be achieved in diabetic patients to prevent this rare entity.