Acute movement disorders with bilateral basal ganglia lesions in uremia

Authors

  • Dr. Han-Cheng Wang MD,

    Corresponding author
    1. Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
    • The Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, 95, Wen Chang Road, Shih Lin District, Taipei, Taiwan
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  • Peter Brown MD,

    1. The National Hospital for Neurology and Neurosurgery, and MRC Human Movement and Balance Unit, Institute of Neurology, Queen Square, London, England
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  • Andrew J. Lees MD, Frcp

    1. The National Hospital for Neurology and Neurosurgery, Institute of Neurology, Queen Square, London, England
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  • A videotape accompanies this article.

Abstract

Acute and subacute extrapyramidal movement disorders are rarely reported in uremic patients. We report three such cases with basal ganglia lesions. All three had advanced renal failure with high serum creatinine levels. One of the patients had a history of ischemic heart disease and acute pulmonary edema with hypoxemia. Another patient had experienced arterial hypotension during previous hemodialysis. The third had prominent metabolic acidosis. One of the patients developed generalized dyskinesias, whereas the other two developed gait disturbances. Neuroimaging studies in all three cases showed bilateral changes in the basal ganglia. The natural history was self-limiting with gradual improvement. Diminution of the basal ganglia lesions was demonstrated on follow-up imaging in two of the three cases. We conclude that acute or subacute movement disorders with bilateral basal ganglia lesions may occur in uremia. Hypoperfusion with global brain ischemia and selective vulnerability of the basal ganglia to uremic toxins may account for these lesions.

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