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

Abstract

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.

Cognitive decline as the main manifestation of diabetic striatal disease but without involuntary movements: a case report

“…When the caudate nucleus was damaged, and the cortex responsible for cognitive function was not damaged or atrophied, the destruction of the limbic system circuit still could lead to confabulation, dementia, speech defects, and neglect syndrome [ 15 ]. What’s more, when the neostriatum is injured, it can lead to increased excitability in the cortical motor area, manifesting typical involuntary movement [ 16 ]. So the patient’s relatively mild neostriatal damage may be the reason of the absence of involuntary movement.…”

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

“…After menopause, decrease of estrogen leads to hypersensitivity phenomenon of dopamine receptor in the substantia nigra striatum system, so that the dopamine function is relatively enhanced. Nonketotic hyperglycemia related hemichorea usually occurs a few weeks later after high blood glucose levels [4] .This response indicates a delayed response to severe hyperglycemia [5] . In our case, there was no symptom when the blood glucose was 30 mmol/L.…”

A Rare Case of Hemichorea-Hemiballismus Due to Chronic Uncontrolled Hyperglycemia

“…The two most common etiologies of hemiballism are stroke (ischemic or hemorrhagic) and non-ketotic hyperglycemia. Other causes, including encephalitis, traumatic brain injury, autoimmune problems, cerebral toxoplasmosis associated with acquired immunodeficiency syndrome (AIDS), mass lesions (neoplasm/cysts), multiple sclerosis, drugs (levodopa, oral contraceptives, and anticonvulsants), metabolic derangements in levels of sodium, calcium, magnesium, and manganese; uremia, toxins such as carbon monoxide, alcohol, aluminum, and lead; and Wilson disease, have been reported [ 6 - 7 ]. These abnormal dyskinetic movements are associated with a subthalamic lesion - a lens-shaped group of nuclei, which inhibits the activity of the ventrolateral thalamus through increased secretion of gamma-aminobutyric acid (GABA) from globus pallidus [ 8 ].…”