Hemiballismus in Uncontrolled Diabetes Mellitus

Abstract

Hemiballismus, a subtype of chorea, is a rare movement disorder, and is most commonly found secondary to stroke. Movements are involuntary, violent, coarse, and have a wide amplitude. There is increasing report of hemiballismus occurring in non-ketotic hyperglycemia. Spontaneous improvements or remissions were observed in many patients, and treatment should be directed towards the cause of hemiballismus. There is no randomized control trial to guide clinicians in deciding the best treatment option when managing hemiballismus. Symptomatic treatment includes the use of drugs such as dopamine receptor blocker and tetrabenazine. Surgical treatment is reserved for severe, persistent, and disabling hemiballismus. This case is of an elderly woman with long standing uncontrolled diabetes who presented with abnormal movement in her left upper limb for 2 months, which resolved slowly with good control of her glucose levels. Treating physicians need to have a high index of suspicion to prevent mismanagement of the condition.

Bilateral striatum with high-signal intensity on T1-weighted MRI: A case of hemichorea induced by nonketotic hyperglycemia

“…The incidence rate of it is about 1/100,000 [3] . It occurs mostly in Asian women over 70-year-old, which may be related to genetic factors and high dopaminergic response due to racial and gender differences.…”

Comparison of Hemichorea-Hemiballism between Acute Stroke and Nonketotic-Hyperglycinemia in the Clinical Scenario: Report of a Rare Diabetic Complication

“…The first and second most common causes of hemichorea-hemiballism are stroke and nonketotic hyperglycemia [3,4,6]. The incidence of poststroke and nonketotic hyperglycemia related hemichoreahemiballism are around 0.08% and 0.001%, respectively [5,6].…”

“…The first and second most common causes of hemichorea-hemiballism are stroke and nonketotic hyperglycemia [3,4,6]. The incidence of poststroke and nonketotic hyperglycemia related hemichoreahemiballism are around 0.08% and 0.001%, respectively [5,6]. Other origins, including demyelinating plaque, amyotrophic lateral sclerosis, traumatic brain injury, Wilson's disease, metabolic derangements, autoimmune disorders, endocrine, infection, neoplasm, drugs and toxin have been reported [6][7][8].…”

“…The incidence of poststroke and nonketotic hyperglycemia related hemichoreahemiballism are around 0.08% and 0.001%, respectively [5,6]. Other origins, including demyelinating plaque, amyotrophic lateral sclerosis, traumatic brain injury, Wilson's disease, metabolic derangements, autoimmune disorders, endocrine, infection, neoplasm, drugs and toxin have been reported [6][7][8]. These movement disorders usually develop while awake and disappear during sleep.…”

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

“…The prevalence of hemichorea-hemiballism is less than 1 in 100,000, and majority of individuals affected are Asian women in their seventh decade. [4] The most common cause is ischemic/hemorrhagic stroke, followed by non-ketotic hyperglycemia. Other factors, such as traumatic brain injury; amyotrophic lateral sclerosis; demyelinating plaque; metabolic derangements in levels of sodium, manganese, magnesium, calcium, and glucose; uremia; thiamin deficiency; endocrine disorders; autoimmune problems; neoplasms; infections; Wilson disease; drugs such as levodopa, oral contraceptives, anticonvulsants, and neuroleptics; and toxins such as carbon monoxide, alcohol, aluminum, and lead have been reported (Table 1).…”