JAMA Diagnosticy: This base knot is high signal and should not be misdiagnosed as acute stroke.

!---- There is a song that sings well: "The world, the world, is a big screen, everyone follows the same footsteps, not as good as dancing..." the rhythmic music, cheerful dance steps, so wonderful.But for an elderly patient friend who is introduced next, he produces dance-like movements that he can't control, and he just wants to shout ,"I want to control myself! "Here's his experience, can you help him make the right diagnosis?" Patient male, in his 60s.was diagnosed with type 2 diabetes for more than 10 years.a month ago, his condition became complicated: the patient began to develop neuropathy and retinopathy, which, despite positive correction with insulin, continued to develop dance disease in the upper left limb.patients became alert to these important symptoms and were admitted to hospital.bedside tests found no evidence of cognitive impairment in patients.nervous system check shows left upper limb dance samples and throwing-like movements, denied recent infections, family medication was carefully checked to eliminate drug-induced dance disorders.patient's previous medical records showed that three weeks ago, the patient had high blood sugar and the patient had a 14.1 percent level of glycated hemoglobin (HbA1c).despite positive corrections of blood sugar levels and metabolic indicators, the patient's dance-like movement did not ease. Afteradmission, the patient underwent a full set of electrolyte and toxicology tests, including calcium, magnesium, phosphorus, all showed normal levels.patients had a blood sugar level of 159 mg/dL (converted to mmol/L, multiplied by 0.055), and glycated hemoglobin level was 10.9%, with no ketones.patients anti-nuclear antibodies, lupus anticoagulants, antiphospholipid antibodies are negative.serum thyroid-stimulating hormone levels and peripheral thyroid hormone levels are averagenormal.liver function detection in the normal range.trace element copper, peripheral blood pictures and conventional electroencephalograms were normal.tumor screening did not show any abnormalities.patient's cranial brain MRI examination (Figure 1) showed a high signal of The right tail nucleus T1, and the bean-like nucleus did not see a mass limitation.give patients oral oxypine 2.5 mg/day, while paying attention to monitoring blood sugar levels, and eventually the patient's dance disease disappears.Figure 1 Patient MRI axial and coronary bit T1 your diagnosis? A. Post-infection/immune dance disease B. Paralytic dance disorder C. Diabetic striatum disease D. Acute stroke "Answer" C. Diabetic striatum discussion: Believe that you have made the correct diagnosis in accordance with the neurology MIDNIGHT principles.we'll have a brief discussion below.patients with diabetic striatum disease showed a dance-like movement of single-sided subacute disease, MRI examination found corresponding brain lesions, and patients have a long history of diabetes, these clues lead us to the diagnosis of diabetic striatum disease.diabetic striatum disease is a combination of neuropathy, manifested in sudden onset of the disease in patients with poor blood sugar control, as well as neuroimaging striatum abnormalities.ketosis hyperglycemia or non-ketogenic hyperglycemia has also been reported.patients' movement disorders (including side dance-side throwing) are due to striatum damage and are often reversible during the internal environmental steady state recovery.diabetic striatum is underdiagnosed in diabetes complications, and people with type 2 diabetes are more likely to experience the disease than people with type 1 diabetes.the main treatments include correcting metabolic disorders through rehydration and insulin. Patients withrecurrent seizures need additional medications, including gamma-aminobutyric acid, antipsychotics, or dopamine exhaustors, as in this case.90% of patients, clinical symptoms will be completely alleviated in 2-28 days, and imaging signals will disappear or not disappear.note that metabolic diseases such as hypersodium emisis or hyponatremia, hypercalcemia or hypocalcemia, hypermagnemia, hyperthyroidism and reduction, parathyroid hyperthyroidism can lead to dance disorders, these problems should be excluded.after infection/immune dance disease small dance disease (Sydenham chorea, SC) is a non-purulent sequeltoe to group A streptococcus infection and rheumatic fever.children are rare and rare for adults.patients with this case have no past history of streptococcus infection and other related symptoms., one-sided dance performance makes SC very unlikely. dance disease can also be an important manifestation of systemic lupus, Sj?gren syndrome, and antiphospholipid syndrome. dance disorders associated with autoimmune diseases are thought to have a common pathophysiological mechanism with post-infection SC. The sub-acute form of dance disease has been found in Creutzfeldt-Jakob variants, HIV infections and slow-growing tumors. patient's MRI performance has ruled out chronic tumors, and clinical courses have ruled out Creutzfeldt-Jakob variants and HIV infections. adhocytic dance synthasis has been reported in cases of kidney cancer, small cell lung cancer, Hodgkin and non-Hodgkin's lymphoma. specific types of movement disorders include dance disorders, which have been reported as side tumor manifestations of anti-NMDA antibody secretion tumors. patients in this case, side-side dance disease and negative screening results suggest that the probability of the origin of the secondary tumor dance disease is very low. Wilson disease Wilson disease is a copper metabolic disorder caused by a mutation in the ATP7B gene, which causes multi-system copper deposition. the decrease in serum copper-blue protein levels in most patients (normal in 5%-15% of patients), reduced serum copper levels, 24-hour increase in urine copper, and visible liver function impairment. and the patient did not see the above abnormality. Wilson's disease is rare and usually on both sides. acute stroke disorder can be an expression of acute ischemic or hemorrhagic stroke, or a manifestation of ischemia in the low-level base section without significant infarction. stroke, which causes side-side dancing disorder, often affects the new striatum and the hypothalamus. less than 1% of stroke patients show side dancing or throwing. patient neuroimaging in this case did not suggest a sign of acute stroke dispersion limitation. most post-stroke patients can have spontaneous remission within 1-2 years. however, there have also been reports that persistent and disabling dance disorders require medication or surgery. diabetic striatum disease is like a "sweet" dance of striatum dedicated to diabetics, sugar is too sweet, dance is too messy, "please let me control myself." .