Acute chorea and bilateral basal ganglia lesions in a hemodialysis patient.

Consciousness disturbance is a common problem in patients undergoing dialysis. For uremia patients who present with consciousness disturbance and specific findings focus on the bilateral ganglions on an imaging study are rare. A 52-year-old female was admitted because of general weakness and drowsy consciousness for one day. Her past history included end-stage renal disease; she had been on regular hemodialysis for 5 years. An abrupt attack of seizure (grand mal) occurred during hospitalization. Computed tomography of the brain showed bilateral basal ganglions with hypo-dense lesions. T1-weighted magnetic resonance (MR) image demonstrated abnormally low-intensity T1 signal at basal ganglions and a high signal on T2-weighted MR image (Picture 1). The underlying etiology of this clinical presentation is not fully understood in our patient. Some studies have suggested that this is related to brain hypo-perfusion, or uremia toxins and it may be closely related to diabetic mellitus (1, 2). Furthermore, the syndrome in uremia patients implies a complicated clinical course and a poor long-term prognosis (1, 2).