Hemichorea-hemiballism: the role of imaging in diagnosing an unusual disorder in patients with nonketotic hyperglycemia

Langer, Felipe Welter; Suertegaray, Gustavo; Santos, Daniela Silva; Alves, Giordano Rafael Tronco; Haygert, Carlos Jesus Pereira

doi:10.1590/0100-3984.2015.0037

Cited by 3 publications

(2 citation statements)

References 6 publications

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“…The use of MRI as a modality to confirm diagnosis is undoubtedly the best. Hyperglycemia without ketosis is associated with the presence of spontaneous hypersignals in the basal ganglia, as observed in previous studies [ 11 , 12 ]. The neuropathological nature of these alterations remains a matter of contention.…”

Section: Discussionsupporting

confidence: 77%

Bilateral Chorea-Ballism Associated With Non-ketotic Hyperglycemia: A Case Report

Abbassi,

Ali Kako,

Mebrouk

2024

Cureus

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The intricate workings of uncontrolled diabetes and its effects on the nervous system are not fully understood. However, it is known that this condition can lead to various neurological manifestations, including altered consciousness and epileptic seizures. In this case study, a 66-year-old woman presented with abnormal ballistic movements and chorea due to severe hyperglycemia. The results of her brain MRI suggested diabetic striatopathy. Fortunately, her symptoms improved significantly with the normalization of blood glucose levels and appropriate medical intervention. While the exact pathophysiology remains elusive, there is speculation that dysfunction of dopaminergic activity may play a role. The management of these complications involves stabilizing blood glucose levels and providing symptomatic relief. Despite the limited understanding of the underlying mechanisms, these neurological complications generally have a positive prognosis.

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Section: Discussionsupporting

confidence: 77%

Bilateral Chorea-Ballism Associated With Non-ketotic Hyperglycemia: A Case Report

Abbassi,

Ali Kako,

Mebrouk

2024

Cureus

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“…The CT scan results, which showed physiological calcification, an old infarct ( Figures 1 , 2 ), and absence of other clinical features, was deemed enough to support the diagnosis of non-ketotic hyperglycemia as the cause of hemiballismus in this patient. Previous literature has also shown that the findings from CT scan results were used to confirm non-ketotic hyperglycemia as the cause for hemiballismus [ 7 ]. The use of MRI as a modality to confirm diagnosis is undoubtedly best; however, in certain circumstances, it is not permissible due to accessibility and cost.…”

Section: Discussionmentioning

confidence: 99%

Hemiballismus in Uncontrolled Diabetes Mellitus

et al. 2018

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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.

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