Acute hemichorea in a newly diagnosed type II diabetes patient: a diagnostic challenge in resource-limited setting: a case report

Ruhangisa, Flora; Stephen, Henry; Senkondo, Jacob; Mwasamwaja, Amos; Kanenda, Said; Mbarak, Saleh; Chamba, Nyasatu; Kilonzo, Kajiru; Howlett, William P.; Lyaruu, Isaack; Shao, Elichilia R

doi:10.1186/s13104-016-2228-7

Cited by 10 publications

(4 citation statements)

References 16 publications

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“…In addition, chorea typically worsens during physical or mental stress and, unlike our patient, disappears after sleep. Only two reported cases have shown no suppression of chorea during sleep [ 33 , 34 ]; thus, our patient may possibly be the third case reported. Finally, it should be mentioned that although the majority of DS cases manifested with chorea/hemichorea, in very rare cases the presentation may occur without chorea but with conscious disturbances [ 31 , 35 ], seizures [ 31 , 36 ], limb weakness, dysarthria [ 37 ], and dysphagia [ 38 ].…”

Section: Discussionmentioning

confidence: 67%

Diabetic Striatopathy: Parenchymal Transcranial Sonography as a Supplement to Diagnosis at the Emergency Department

Godani¹,

Lanza

2022

Diagnostics

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Background: Diabetic striatopathy (DS) is a rare condition with a debated pathophysiology; a local metabolic dysfunction is the most likely hypothesis. We present a case of DS mimicking an acute stroke, outline a few uncommon/atypical features, and report for the first time the parenchymal transcranial sonography (pTCS) findings. Case Report: An 86-year-old man, treated for insulin-dependent diabetes, presented at an emergency department because of the occurrence of isolated choreo-athetotic movements in his left limbs with fluctuations in the location, frequency, and duration. The blood glucose level was 569 mg/dL. Both urgent and follow-up brain computed tomography (CT) were negative for recent lesions whereas pTCS revealed hyperechogenicity in the right lenticular nucleus. Subsequent magnetic resonance imaging (MRI) showed T1-weighted hyperintensity in the right putamen with negative diffusion-weighted imaging. The symptoms were responsive to glucose control and haloperidol administration, although they persisted during sleep. Conclusions: Unlike previously described cases characterized by hemichorea and/or hemiballism, our patient presented with a stroke-like onset of unilateral irregular choreo-athetotic movements. Notably, based on CT alone, it would not have been possible to distinguish DS from a stroke. In this scenario, the pTCS hyperechogenicity of the right lenticular nucleus helped to hypothesize a metabolic disorder, which was subsequently confirmed by MRI.

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Section: Discussionmentioning

confidence: 67%

Diabetic Striatopathy: Parenchymal Transcranial Sonography as a Supplement to Diagnosis at the Emergency Department

Godani¹,

Lanza

2022

Diagnostics

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“…The acute nature of his symptoms and the lack of fever helped rule out neurogenetic and infectious causes, making DS more likely. However, it is important to note that our patient's presentation was atypical in that the HBHC did not disappear with sleep; there are only two reported cases of DS that showed no suppression of HBHC during sleep [ 11 , 12 ].…”

Section: Discussionmentioning

confidence: 90%

A Case Report of Diabetic Striatopathy: An Approach to Diagnosis Based on Clinical and Radiological Findings

Park¹,

Kesserwani²

2022

Cureus

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Diabetic striatopathy (DS) is an acute hyperkinetic movement disorder characterized by hemiballismus-hemichorea (HBHC) due to nonketotic hyperglycemia. DS manifests a fascinating interplay between endocrinopathy (diabetes), striatal (putamen, caudate nucleus, globus pallidus) pathology, and a dramatic neurological movement disorder, HBHC. The striking hyperintensity on imaging modalities such as computed axial tomography (CT) scan of the brain and T1-weighted magnetic resonance imaging (MRI) of the brain can mislead the clinician to an erroneous diagnosis of a cerebral hemorrhage and/or ischemic infarct, especially in an acute setting. We present an acute case of DS and outline the natural history, semiology, typical radiological findings, and therapeutic options. With careful and thoughtful analysis, an accurate diagnosis can be exacted, sparing the patient unnecessary anxiety and medical costs.

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“…In our patient, the possible mechanisms of non-ketotic hyperglycemia-related hemichorea-hemiballism are the disruption of the blood brain barrier (BBB) owing to hyperglycemia-induced blood hyperviscosity; anaerobic metabolism of brain cells resulting from decreased regional cerebral blood flow and glucose metabolism failure; augmented sensitivity of dopaminergic receptors in postmenopausal women owing to declined estrogen concentration; or decreased gamma-aminobutyric acid (GABA) availability in the striatum secondary to the non-ketotic state. [6–11] Disrupted BBB causes transient ischemia of vulnerable striatal neurons. Imbalanced dopamine and GABA systems and vascular insufficiency could further contribute to movement disorders.…”

Section: Discussionmentioning

confidence: 99%

Investigation of the relationship between non-ketotic hyperglycemia and hemichorea-hemiballism

Hsiao

Kuo

et al. 2019

Medicine

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Rationale: Hemichorea-hemiballism, a rare manifestation of non-ketotic hyperglycemia, characterized by involuntary arrhythmic motions involving one side of the body, results from focal lesions in the contralateral caudate nucleus and putamen. Hyperkinetic disorders can be complications of uncontrolled diabetes mellitus and should not be ignored. Patient concerns: We present the case of a 39-year-old woman who presented to the emergency department with a 3-day history of left-sided hemichorea-hemiballism. She had type 2 diabetes mellitus with poor control and maintenance of regular hemodialysis. Diagnoses: The patient was diagnosed as hyperglycemia, normal ketone body and hemichorea-hemiballism based on laboratory examination, computed tomography (CT) scan, and brain magnetic resonance image (MRI). Interventions: Intensive glycemic control via insulin injection was prescribed for correction of hyperglycemia. Outcomes: The unilateral involuntary movements subsided progressively over four weeks. The patient's hemichorea had completely resolved at the three-month follow-up. Lessons: This unusual clinical presentation is often accompanied by severe hyperglycemia. Appropriate blood glycemic control is important. If physicians recognize and provide early treatment for this disease, it is usually treatable and has a good prognosis.

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Acute hemichorea in a newly diagnosed type II diabetes patient: a diagnostic challenge in resource-limited setting: a case report

Cited by 10 publications

References 16 publications

Diabetic Striatopathy: Parenchymal Transcranial Sonography as a Supplement to Diagnosis at the Emergency Department

Diabetic Striatopathy: Parenchymal Transcranial Sonography as a Supplement to Diagnosis at the Emergency Department

A Case Report of Diabetic Striatopathy: An Approach to Diagnosis Based on Clinical and Radiological Findings

Investigation of the relationship between non-ketotic hyperglycemia and hemichorea-hemiballism

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