Hyperglycemia-associated Hemichorea-hemiballism: The Spectrum of Clinical Presentation

Abstract

Hyperglycemia rarely manifests as hemichorea-hemiballism (HH), which is characterized by simple partial motor seizures. One of the difficulties in the management of hyperglycemia-induced HH is the failure to recognize this entity due to its relatively uncommon presentation. We herein present a case series of hyperglycemia-associated dyskinesias, highlighting the different possible clinical presentations of this entity. Both hyperglycemia and hyperosmolality are probable predisposing factors, while ketoacidosis has a protective role in preventing the dyskinesias. One of our patients had ketotic hyperglycemia leading to HH, a previously unreported finding. Early recognition of this entity is crucial as prompt glycemic control leads to the resolution of symptoms and signs.

Sertraline-induced Hemichorea

“…In our patient we ruled out chorea gravidarum, post-streptococcal chorea, autoimmune-mediated hemichorea, polycythemia vera, and vascular and structural causes, among others. 1 While in this case a personal history of smoking could be observed as a risk factor for hemichorea development, in the literature only one case of smoking was reported as a worsening and non-primary causal factor in a 65-year-old hypertensive male with a right putamen hemorrhage. 16 In our patient, smoking did not seem to be involved in the pathogenesis of the hemichorea.…”

“…It usually results from a lesion in the contralateral basal ganglia structure, but it is also a well-recognized complication of several conditions, including non-ketotic hyperglycemia and polycythemia vera. 1 Although induced parkinsonisms and other hyperkinetic movement disorders are repeatedly reported with selective serotonin reuptake inhibitors (SSRIs), 2,3 drug-induced hemichorea has rarely been reported [4][5][6][7][8][9] (Table 1). Herein we report a case of hemichorea induced by sertraline.…”

Sertraline-induced Hemichorea

“…In our patient we ruled out chorea gravidarum, post-streptococcal chorea, autoimmune-mediated hemichorea, polycythemia vera, and vascular and structural causes, among others. 1 …”

“…It usually results from a lesion in the contralateral basal ganglia structure, but it is also a well-recognized complication of several conditions, including non-ketotic hyperglycemia and polycythemia vera. 1 …”

Glycaemic chorea

“…Dopamine-receptor antagonists can be used if symptoms do not resolve with stabilisation of blood glucose alone 1,3 . We propose glycaemic chorea as a name for this condition, given it can occur with hyper or hypoglycaemia 1 and in the setting of ketoacidosis 4 Glycaemic chorea is a rare, but important complication of diabetes. This patient’s chorea could have been caused by hyper or hypoglycaemia.…”