Chorea associated with nonketotic hyperglycemia

Chang, Xian‐Chao; Hong, Wenke; Yu, Hao; Yao, Yindan

doi:10.1097/md.0000000000008602

Cited by 23 publications

(35 citation statements)

References 12 publications

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“…One case showed leukoaraiosis and multiple cortical ischemia, but no hyperintensisty in putamen [9]. A recent study reported that a DC patient with nonketoic hyperglycemia did not show any abnormalities in the brain MRI and computed tomography (CT) [10]. In our case, patient 2 did not show typical DC symptoms, such as high intensity area in basal ganglia in the brain MRI.…”

Section: Discussioncontrasting

confidence: 41%

“…In addition, the lack of evidence for atherosclerotic lesions in the carotid artery ultrasonography and the brain magnetic resonance angiography added to a lack of arrhythmias support the notion that these multiple small hyperintensities did not represent atherosclerotic lesions in our patient 2. Chang et al proposed two types of DC: a common type showing hyperglycemia, choreic movement with typical radiographic imaging in brain MRI or CT and uncommon type showing chorea with negative imaging changes [10]. Patient 2 exhibited uncommon type of DC.…”

Section: Discussionmentioning

confidence: 99%

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Different Magnetic Resonance Imaging Manifestations of Diabetic Chorea in a Case with Hyperglycemia and Another One with Hypoglycemia

Yamada¹,

Saikawa²,

Suzuki³

et al. 2018

CRCM

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Diabetic chorea (DC) is a rare complication of diabetes. Here we describe two cases of DC; patient 1 was an 87-year-old woman with chronic kidney disease and was administered with sulphonylurea and dipeptidylpeptodase-4 inhibitor. She showed right side hemiballismus and head magnetic resonance imaging T1-weighted images revealed a high intensity area in the putamen and caudate nucleus. Patient 2 was a 51-year-old woman who was diagnosed with diabetic ketoacidosis. She showed right side hemiballism and multiple, small hyperintense regions in both the periventricular sides in diffusion weighted images. Based on the hemiballism, we concluded a diagnosis of DC in the diabetic patient, although the case presentation is rare or has atypical MRI findings.

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Section: Discussioncontrasting

confidence: 41%

Section: Discussionmentioning

confidence: 99%

Different Magnetic Resonance Imaging Manifestations of Diabetic Chorea in a Case with Hyperglycemia and Another One with Hypoglycemia

Yamada¹,

Saikawa²,

Suzuki³

et al. 2018

CRCM

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“…The characteristic radiographic manifestations of non-ketotic hyperglycemia-related hemichorea-hemiballism are high-density changes in brain CT, high signal changes in brain MRI T1-weighted sequences, and equal or low signal in MRI T2-weighted sequences of the contralateral striatum. [14–17] Clinicians may interpret the initial high-density lesion of brain CT as acute hemorrhage. The hyperglycemic state promotes deposition of a T1-intense mineral, such as calcium or manganese, which recovers after glucose is normalized.…”

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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“…Berbagai kondisi seperti penyakit neurodegeneratif, serebrovaskular, imunologi, neoplastik, infeksi, dan kelainan metabolik dikenal sebagai penyebab sekunder dari HCHB. 4 Ingle dan Gupta tahun 2016 melaporkan bahwa stroke iskemik akut biasanya ditandai dengan gejala seperti paresis/paralisis anggota gerak atau kebas. Adapun gejala yang jarang terjadi pada stroke iskemik akut adalah gangguan gerak hiperkinetik seperti HCHB, mioklonus, tics, dan tremor rubral.…”

Section: Pendahuluanunclassified

Hemichorea/Hemibalismus Dengan Hiperglikemia Nonketotik Pada Stroke Iskemik Akut

Safridawat

Hidayaturrahmi

Wanda

et al. 2020

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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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Chorea associated with nonketotic hyperglycemia

Cited by 23 publications

References 12 publications

Different Magnetic Resonance Imaging Manifestations of Diabetic Chorea in a Case with Hyperglycemia and Another One with Hypoglycemia

Different Magnetic Resonance Imaging Manifestations of Diabetic Chorea in a Case with Hyperglycemia and Another One with Hypoglycemia

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

Hemichorea/Hemibalismus Dengan Hiperglikemia Nonketotik Pada Stroke Iskemik Akut

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