Irreversible Hemichorea–Hemiballism in a Case of Nonketotic Hyperglycemia Presenting as the Initial Manifestation of Diabetes Mellitus

Abstract

Background: Hemichorea-hemiballism (HCHB) is a hyperkinetic movement disorder with features of both chorea and ballism occurring on the same side.Case report: We present a case of HCHB due to nonketotic hyperglycemia (NKH) that was the initial presentation of diabetes and was irreversible clinically even after 6 months of optimal blood sugar control.Discussion: Although HCHB due to hyperglycemia is a potentially reversible condition in the majority of patients, prolonged uncontrolled hyperglycemia may cause ischemic insult and persistent symptoms. Hyperglycemia should always be kept in the list of differentials while dealing with patients who are newly diagnosed with HCHB.

Hemichorea Associated With Non-ketotic Hyperglycemia: A Case Report and Literature Review

“…Hemichorea associated with non-ketotic hyperglycemia (HC-NH) is a rare complication of diabetes mellitus (3), which is commonly seen in elderly diabetic women with poor blood glucose control. HC-NH was first described in 1960 (4) and is characterized by non-ketotic hyperglycemia, unilateral involuntary choreiform movements, and contralateral basal ganglia hyper-intensity on T1-weighted MR images or high density on CT scans (5).…”

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

“…However, sometimes, dopamine depletion agents, such as haloperidol or tetrabenazine [13], and rarely for refractory cases, repetitive transcranial magnetic stimulation [14] or deep brain stimulation [15] are needed to control the symptoms. Symptoms usually resolve completely within six months to one year but, sometimes, chorea can persist for one to two years [16].…”

Chorea Associated with Nonketotic Hyperglycemia: A Case Report

“…There is a recent report with striatal hyperglycemic nonketotic signal changes occurring in the setting of a front temporal craniotomy for resection of a sphenoid wing meningioma [3]. It can be an initial presentation of diabetes mellitus [4]. Yet, it also presented in patients with normal blood glucose but history of poor diabetic control [5].…”