Diabetic Striatopathy in a Child: A Cause of Reversible Chorea
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Plastic bronchitis is one of the extreme presentations of allergic airway disorders. Animal dander exposure is common in developing world where increasing number of allergies are being recognized. The index case highlights the unique presentation of possible buffalo dander hypersensitivity in an atopic infant.
Diabetic Striatopathy in a Child: A Cause of Reversible Chorea
urine was positive for glucose and negative for ketones. CSF analysis was normal. A diagnosis of type 2c DM was made. She was started on insulin (basal-bolus) regimen. Seizures were controlled with anticonvulsant therapy.
RITIKA CHHAWCHHARIA1, NEERAJ GUPTA1*, DHIREN GUPTA1 AND POOJAN AGARWAL2 Departments of 1Pediatric Pulmonology and Allergy, 2Pathology, Sir Ganga Ram Hospital, New Delhi, India. *[email protected] REFERENCES 1. Madsen P, Shah SA, Rubin BK. Plastic bronchitis: New insights and a classification scheme. Paediatr Respir Rev. 2005; 6: 292-300. 2. Singhi AK, Vinoth B, Kuruvilla S, Sivakumar K. Plastic bronchitis. Ann Pediatr Cardiol. 2015;8:246-8. 3. Werkhaven J, Holinger LD. Bronchial casts in children. Ann Otol Rhinol Laryngol. 1987;96:86-92. 4. Kumar A, Jat KR, Srinivas M, Lodha R. Nebulized NAcetylcysteine for management of plastic bronchitis. Indian Pediatr. 2018;55:701-3. 5. Bowen AD, Oudjhane K, Odagiri K, Liston SL, Cumming WA, Oh KS. Plastic bronchitis: Large branching mucoid bronchial casts in children. Am J Roentgenol.1985; 144: 371-5.
On day-9 of admission, she developed low amplitude irregular abnormal movements of fingers, high frequency jerks involving both upper limbs, progressing to involve lower limbs and face. MRI brain showed T1-hyperintensities involving bilateral striatal regions with abnormal T2/ FLAIR signals with blooming on gradient-echo images and minimal restriction on diffusion-weighted images, consistent with non-ketotic hyperglycemic hemichorea syndrome. Symptomatic treatment with haloperidol, tetrabenezine, clonazepam and valproate was given. A reduction in the dyskinetic symptoms was seen by day 30 with adequate glycemic control. She was discharged on day 45 with minimal symptoms.
The neurological manifestations of diabetes mellitus (DM) include altered mentation, convulsions, dyskinesia, paresthesia and coma. Dyskinesia including chorea and ballism are rare manifestations often encountered in elderly females of Asian descent [1], concurrently with hyperglycemic hyperosmolar state or diabetic ketoacidosis. Incidence of diabetic striatopathy in children is rare and characterized by myriad of symptoms including movement abnormalities like chorea-ballism and abnormality in striatum on neuroimaging. Till date, only six pediatric cases have been documented worldwide with two from India [1,2].
Diabetic striatopathy is a known complication of chronic uncontrolled hyperglycemia in adults with type 2 DM, which may be the only manifestation of underlying diabetes in the elderly [3]. This is the first case of a child with diabetic striatopathy secondary to type 2c DM. Affected patients are non-ketonemic,
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