背景：基底核病變發生於糖尿病及尿毒患者逐漸獲得重視，已被報告的檢查工具包括核磁共振影像、核磁共振質譜儀、正子造影及灌注單光子射出電腦斷層掃描。在此，我們利用未被報告的鎝－99m-TRODAT-1單光子射出電腦斷層掃描及經顱磁刺激器(transcranial magnetic stimulation)來研究一位糖尿病及尿毒患者發生急性可逆性半側帕金森氏症。個案報告：這位62歲糖尿病及尿毒患者入院表現為急性右側帕金森氏症、構音困難及吞嚥障礙。核磁共振影像發現左側豆狀核顯影劑增強；核磁共振質譜儀及正子造影發現雙側豆狀核病變；鎝－99m-TRODAT-1單光子射出電腦斷層掃描發現左側紋狀體的多巴胺轉運體明顯缺損；經顱磁刺激器則發現異常短的皮質隱藏期(cortical silent period)。結論：基底核病變發生於糖尿病及尿毒患者也可以不對稱方式來表現，進而造成半側帕金森氏症。利用鎝－99m-TRODAT-1單光子射出電腦斷層掃描及經顱磁刺激器可以反應出臨床表現。

Background: There exists growing medical awareness regarding the syndrome bilateral basal ganglia lesions for patients suffering from diabetes mellitus and uremia. Neuroimaging findings for such patients have been described previously for several different imaging modalities, including magnetic resonance (MR) imaging, MR spectroscopy, positron emission tomography (PET), and perfusion single photon emission computed tomography (SPECT). Herein, we have attempted to correlate the clinical features of hemi-parkinsonism by conducting two additional investigating modalities, 99mTc-TRODAT-1 SPECT and transcranial magnetic stimulation (TMS) studies. Case report: A 62-year-old diabetic uremic male patient presented with acute right hemi-parkinsonism, dysarthria and dysphagia. Head MR imaging revealed focal enhancement within the left lenticular nuclei. MR spectroscopy displayed findings such as a symmetrical N-acetyl aspartate (NAA) reduction and a bilateral inverted lactate peak within the lenticular nuclei. PET also disclosed a bilateral low uptake of FDG within the lenticular nuclei, although this effect was more pronounced on the left side. 99mTc-TRODAT-1 SPECT demonstrated a low uptake of dopamine transporter in the left putamen. TMS study revealed a shorter cortical silent period (CSP) for right abductor digiti minimi (ADM) muscles. Conclusion: Bilateral basal ganglia lesions may occur in an asymmetrical manner. Consequently, hemi-parkinsonism is one of the clinical manifestations. These new findings of asymmetrical low uptake upon a dopamine transporter scan and a reduced cortical silent period for the affected side could be correlated with hemi-parkinsonism. Thus, 99mTc-TRODAT-1 SPECT and TMS-CSP modalities are able to serve as clinical correlates.