HEMICHOREA/HEMIBALLISM ASSOCIATED WITH NONKETOTIC HYPERGLYCEMIC ON ACUTE ISCHEMIC STROKEABSTRACTHemichorea/hemiballism (HCHB) associated with nonketotic hyperglycemia in acute ischemic stroke is a well-recognized syndrome characterized by the sudden occurrence of hemichorea or more severe expression like hemiballism. The hyperkinetic movements involve the face, arm, or leg. HCHB in acute ischemic stroke is a movement disorder that is rarely reported with hyperkinetic movement. This case report aimed to describe patient with HCHB associated with hyperglycemia as prior sign of stroke ischemic and propose a possible pathophysiology. We report three patients who had HCHB accompanied by hemiparesis, facial and hypoglossus nerve palsy. Laboratory results showed increased serum glucose levels and negative urine ketones. Imaging findings of head CT scan found an infarction in the basal ganglia. Patients are treated with antiplatelet and or anticoagulant therapy and correction of hyperglycemia with additional therapy of dopamine receptor antagonistThe combination of a recent or old striatal lesion and hyperglycemia induce HCHB, causing increased inhibition of the subthalamic nucleus and causing decreased GABAergic inhibition of the thalamus. Diabetes mellitus should always be suspected in patients who develop HCHB movements. When hyperglycemia is detected and treated, movement disorders resolve within a few days and the administration of dopamine receptor antagonists can be considered.Keywords: Hemiballism, hemichorea, hyperglycemia, ischemic strokeABSTRAKHemichorea/hemibalismus (HCHB) yang berhubungan dengan hiperglikemia nonketotik pada stroke iskemik akut adalah sindrom yang ditandai oleh munculnya hemichorea yang terjadi secara tiba-tiba atau disertai dengan gejala yang lebih berat, seperti hemibalismus. Pergerakan hiperkinetik meliputi wajah, lengan dan tungkai. HCHB pada stroke iskemik akut merupakan gangguan pergerakan hiperkinetik yang jarang dilaporkan. Laporan kasus ini bertujuan untuk menggambarkan pasien yang mengalami keluhan HCHB sebagai gejala awal terjadinya stroke iskemik disertai dengan hiperglikemia dan memperkirakan penjelasan patofisiologi yang mungkin terjadi pada pasien ini. Kami melaporkan tiga pasien dengan keluhan HCHB sebagai gejala awal stroke iskemik akut yang disertai hiperglikemia. Pada ketiga kasus tersebut keluhan disertai dengan paresis nervus fasialis, hipoglossus serta hemiparesis ekstremitas kontralateral lesi. Kadar glukosa serum meningkat dan keton urin negatif. Gambaran CT scan menunjukkan adanya infark di ganglia basalis. Pada tata laksana kami menemukan bahwa koreksi hiperglikemi disertai pemberian terapi antikoagulan dan atau antiplatelet serta agen neuroleptik dapat menyebabkan perbaikan luaran pada gejala HCHB secara perlahan. Kombinasi lesi striatal baru dan hiperglikemia dapat menginduksi terjadinya HCHB karena kedua hal tersebut dapat menyebabkan peningkatan inhibisi inti subtalamik dan gangguan inhibisi GABAergic talamus. Diabetes melitus harus selalu dicurigai pada pasien dengan keluhan HCHB. Ketika hiperglikemia terdeteksi dan ditatalaksana, gangguan gerakan menghilang dalam beberapa hari dan dapat dipertimbangkan dengan pemberian terapi neuroleptik.Kata kunci: Hemibalismus, hemichorea, hiperglikemia, stroke iskemik
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