Management of Severe Hemiballismus: Treatment Challenges in the Acute Inpatient Rehabilitation Setting: A Case Presentation

Abstract

V.

Hemiballismus in Patients With Poorly Controlled Type 2 Diabetes Mellitus

“…3,11 These abnormalities in turn interrupt the signaling cascade with abnormal firing rates or firing patterns, leading to reduced inhibition of the motor thalamus and ultimately present as hemiballismus. 1,3,7 While most cases presented with unilateral hyperkinesis and associated contralateral basal ganglia abnormalities, there are reports of both unilateral and bilateral movements associated with bilateral basal ganglia hyperintensities on imaging. 9 The predilection for unilateral brain lesions may be explained by the varying degree of small vessel disease in different areas of the brain leading to perfusion deficits worsened by hyper viscosity.…”

“…1,3,4 Other causes include HIV, traumatic brain injury, encephalitis, vasculitis, mass effect, multiple sclerosis, and adverse drug reactions. [4][5][6][7] Acute or subacute hemiballismus is classically attributed to a lesion in subthalamic nucleus (STN), but this is true only in a minority of cases. Hemiballismus can be caused by any abnormality in various subnuclei of the basal ganglia, including the classic location in the STN, striatum, and globus pallidus.…”

“…Reported cases have been limited to small numbers of patients with only a few larger-scale reviews of more than 20 patients. 7,9 Most reported cases involve geriatric patients and more commonly, females of Eastern Asian descent with an average age of onset of 71 years. 4,10 Patients typically present with glucose levels from 500 to 1,000 mg/dL and hemoglobin A 1c (HbA 1c ) levels almost double the normal values.…”