A syndrome of bilateral symmetrical basal ganglia lesions in diabetic dialysis patients.

A rare syndrome of acute symmetrical bilateral basal ganglia lesions in diabetic dialysis patients that manifests clinically with headache, dysarthria, and gait and movement disorder has been described almost exclusively in patients of Asian descent. The pathophysiology of this condition has not been established. Of the 28 cases reported, 3 patients have been from North America. In the context of magnetic resonance imaging showing dramatic resolution of lesions of the basal ganglia, this report describes a fourth case from North America of a 47-year-old Hispanic woman with diabetes on dialysis therapy who presented with headache, unsteady gait, and slurred speech. We also consider presymptomatic metabolic abnormalities in the pathogenesis of this disease.