Skip to main content


Log in

Acute bilateral basal ganglia lesions in diabetic uraemia: diffusion-weighted MRI

  • Diagnostic Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript



We studied four patients with diabetes mellitus and chronic renal failure who developed sudden choreic movement disorders. The clinical manifestations, laboratory findings, MR imaging findings, and clinical outcome in each patient were evaluated.


All four patients had long-term diabetes mellitus and severe azotaemia. Brain MR findings consisted of bilateral symmetric basal ganglia lesions, with decreased signal intensity on T1-weighted images and increased signal intensity on T2-weighted images. All three patients who underwent diffusion-weighted MR imaging (DWI) showed signal intensities similar to those of the surroundings in regions corresponding to increased signal intensity on T2-weighted images, with slightly increased apparent diffusion coefficient (ADC) values. Two of the patients showed small focal areas of restricted diffusion within the basal ganglia lesions. After haemodialysis, follow-up MR imaging in all patients demonstrated that the basal ganglia lesions had regressed markedly, with some residual changes. The movement disorders also improved in all patients.


A syndrome associated with acute bilateral basal ganglia lesions in diabetic uraemic patients is rare, with reversible changes demonstrated by clinical and imaging findings. DWI showed that the bilateral basal ganglia lesions in this syndrome were primarily vasogenic in origin, although there were small foci of cytotoxic oedema within the lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others


  1. Raskin NH, Fishman RA (1976) Neurologic disorders in renal failure. N Engl J Med 294:143–148

    Article  PubMed  CAS  Google Scholar 

  2. Wang HC, Cheng SJ (2003) The syndrome of acute bilateral basal ganglia lesions in diabetic uremic patients. J Neurol 250:948–955

    Article  PubMed  Google Scholar 

  3. Wang HC, Brown P, Lees AJ (1998) Acute movement disorders with bilateral basal ganglia lesions in uremia. Mov Disord 13:952–957

    Article  PubMed  CAS  Google Scholar 

  4. Lee PH, Shin DH, Kim JW, Song YS, Kim HS (2006) Parkinsonism with basal ganglia lesions in a patient with uremia: evidence of vasogenic edema. Parkinsonism Relat Disord 12:93–96

    Article  PubMed  Google Scholar 

  5. Wang HC, Hsu JL, Shen YY (2004) Acute bilateral basal ganglia lesions in patients with diabetic uremia: an FDG-PET study. Clin Nucl Med 29:475–478

    Article  PubMed  Google Scholar 

  6. Cupidi C, Piccoli F, La Bella V (2006) Acute reversible parkinsonism in a diabetic-uremic patient. Clin Neurol Neurosurg 108:601–603

    Article  PubMed  Google Scholar 

  7. Mukherjee P, McKinstry RC (2001) Reversible posterior leukoencephalopathy syndrome: evaluation with diffusion-tensor MR imaging. Radiology 219:756–765

    PubMed  CAS  Google Scholar 

  8. Schmidt M, Sitter T, Lederer SR, Held E, Schiffl H (2001) Reversible MR changes in a patient with uremic encephalopathy. J Nephrol 14:424–427

    PubMed  CAS  Google Scholar 

  9. Kim TK, Seo SI, Kim JH, Lee NJ, Seol HY (2006) Diffusion-weighted magnetic resonance imaging in the syndrome of acute bilateral basal ganglia lesions in diabetic uremia. Mov Disord 21:1267–1270

    Article  PubMed  Google Scholar 

  10. Cotton F, Kamoun S, Rety-Jacob F, Tran-Minh VA, Nighoghossian N, Hermier M (2005) Acute hypertensive encephalopathy with widespread small-vessel disease at MRI in a diabetic patient: pathogenetic hypotheses. Neuroradiology 47:599–603

    Article  PubMed  CAS  Google Scholar 

  11. Raghavendra S, Ashalatha R, Thomas SV, Kesavadas C (2007) Focal neuronal loss, reversible subcortical focal T2 hypointensity in seizures with a nonketotic hyperglycemic hyperosmolar state. Neuroradiology 49:299–305

    Article  PubMed  CAS  Google Scholar 

  12. Port JD, Beauchamp NJ (1998) Reversible intracerebral pathologic entities mediated by vascular autoregulatory dysfunction. Radiographics 18:353–367

    PubMed  CAS  Google Scholar 

  13. New DI, Chesser AM, Thuraisingham RC, Yaqoob MM (2003) Cerebral artery response to pressure and flow in uremic hypertensive and spontaneously hypertensive rats. Am J Physiol Heart Circ Physiol 284:H1212–H1216

    PubMed  CAS  Google Scholar 

  14. Lee YH (2005) Diabetic nephropathy with acute symmetrical changes in the basal ganglia regions. Clin Radiol 60:815–820

    Article  PubMed  Google Scholar 

  15. Okada J, Yoshikawa K, Matsuo H, Kanno K, Oouchi M (1991) Reversible MRI and CT findings in uremic encephalopathy. Neuroradiology 33:524–526

    Article  PubMed  CAS  Google Scholar 

  16. Ahn KJ, You WJ, Jeong SL, et al (2004) Atypical manifestations of reversible posterior leukoencephalopathy syndrome: findings on diffusion imaging and ADC mapping. Neuroradiology 46:978–983

    Article  PubMed  CAS  Google Scholar 

  17. Chen CL, Lai PH, Chou KJ, Lee PT, Chung HM, Fang HC (2007) A preliminary report of brain edema in patients with uremia at first hemodialysis: evaluation by diffusion-weighted MR imaging. AJNR Am J Neuroradiol 28:68–71

    PubMed  CAS  Google Scholar 

  18. Tarhan NC, Agildere AM, Benli US, Ozdemir FN, Aytekin C, Can U (2004) Osmotic demyelination syndrome in end-stage renal disease after recent hemodialysis: MRI of the brain. AJR Am J Roentgenol 182:809–816

    PubMed  Google Scholar 

  19. Lee EJ, Choi JY, Lee SH, Song SY, Lee YS (2002) Hemichorea-hemiballism in primary diabetic patients: MR correlation. J Comput Assist Tomogr 26:905–911

    Article  PubMed  Google Scholar 

  20. Ertl-Wagner B, Jansen O, Schwab S, Sartor K (1999) Bilateral basal ganglion hemorrhage in diabetic ketoacidotic coma: case report. Neuroradiology 41:670–673

    Article  PubMed  CAS  Google Scholar 

  21. Watanabe Y, Mitomo M, Tokuda Y, et al (2002) Eclamptic encephalopathy: MRI, including diffusion-weighted images. Neuroradiology 44:981–985

    Article  PubMed  CAS  Google Scholar 

  22. Brami-Zylberberg F, Meary E, Oppenheim C (2005) Abnormalities of the basal ganglia and thalami in adults. J Radiol 86:281–293

    PubMed  CAS  Google Scholar 

  23. Ho VB, Fitz CR, Chuang SH, Geyer CA (1993) Bilateral basal ganglia lesions: pediatric differential considerations. Radiographics 13:269–292

    PubMed  CAS  Google Scholar 

Download references

Conflict of interest statement

We declare that we have no conflict of interest.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Eun Ja Lee.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee, E.J., Park, JH., Ihn, Y.k. et al. Acute bilateral basal ganglia lesions in diabetic uraemia: diffusion-weighted MRI. Neuroradiology 49, 1009–1013 (2007).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: