Non-ketotic hyperglycemia unmasks hemichorea

Danve, Abhijeet; Kulkarni, Supriya; Bhoite, Girija Ramesh

doi:10.3402/jchimp.v5.27825

Cited by 11 publications

(8 citation statements)

References 16 publications

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“…According to a meta-analysis, the average age of HC-NH patients is 71 years old, with a male-to-female ratio of 1-1.8 (6). HC-NH mostly occurs in non-ketotic diabetic patients with poor blood glucose control in the past (3), sometimes in ketotic diabetic patients (7), and occasionally in adolescents with newly-diagnosed diabetes (8).…”

Section: Introductionmentioning

confidence: 99%

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

Zheng

Chen

et al. 2020

Front. Neurol.

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Objective: To explore the clinical manifestation, diagnosis, therapy, and mechanism of hemichorea associated with non-ketotic hyperglycemia (HC-NH) so as to enhance awareness and avoid misdiagnosis or missed diagnosis of the disease. Methods: A case of HC-NH was reported and reviewed in terms of the clinical features, diagnosis and treatment. Results: Hemichorea associated with non-ketotic hyperglycemia is a rare complication of diabetes mellitus, which is commonly seen in elderly women with poorly-controlled diabetes. The condition is characterized by non-ketotic hyperglycemia, unilateral involuntary choreiform movements, and contralateral basal ganglia hyper-intensity by T1-weighted MR imaging or high density on CT scans. Blood glucose control is the basal treatment, in combination with dopamine receptor antagonists and benzodiazepine sedative, in controlling hemichorea. Conclusion: In clinical practice, the possibility of unilateral chorea should be considered for diabetic patients with poor blood glucose control.

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Section: Introductionmentioning

confidence: 99%

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

Zheng

Chen

et al. 2020

Front. Neurol.

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“…Incompatibility in correlating laterality of the lesion on neuroimaging and involved side of abnormal movements has been observed in cases of DS. Some patients with unilateral neuroradiological lesions manifest chorea in bilateral limbs [1], whereas some with bilateral striatal lesions show the unilateral manifestation of chorea [20]. Surprisingly, some show symptoms in the side of the body ipsilateral to the side of the neuroradiological lesion [21, 22].…”

Section: Resultsmentioning

confidence: 99%

Neuroimaging of Diabetic Striatopathy: More Questions than Answers

Dubey

Biswas²,

Ghosh

et al. 2022

Eur Neurol

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Background: Diabetic striatopathy (DS), coined as a generic term, has been defined as a hyperglycemic condition associated with either one of the two following conditions: chorea/ballism or striatal hyperdensity on computed tomography or striatal hyperintensity on T1-weighted magnetic resonance imaging. This review highlights those “gray areas,” which need further exploration to understand better hyperglycemia-induced striatal changes and diverse movement disorder phenotypes associated with these changes. Results and Discussion: We searched in PubMed and Google Scholar the terms “diabetes mellitus,” “movement disorders,” “diabetic striatopathy,” “chorea,” “hemichorea,” “ballism,” “hemichorea-hemiballism,” and “neuroradiology” in various combinations (time range from 1980 to March 2022). We selected the publications about our topic of discussion. Summary: Hemichorea-hemiballismus is the most commonly associated movement disorder in DS, and the putamen is the most frequently affected anatomical region. The exact pathophysiological mechanisms remain elusive. Clinical-radiological discordance is not rare. Complete reversal of symptoms with the resolution of the imaging findings is the most prevalent outcome in patients with DS. Dramatic improvement of chorea can be achieved by either insulin monotherapy or combination therapy of insulin and D2-blocker or, in some cases, even spontaneously. Conclusion: The term “diabetic striatopathy” is ambiguous and controversial. Pathological mechanisms behind clinical-radiological discordance in hyperglycemia-induced striatopathy need further exploration through well-designed studies. We propose a classification of DS that includes symptomatic DS (striatal neuroimaging lesions in association with a clinically evident movement disorder and hyperglycemia), clinically isolated DS (clinically evident movement disorders without striatal changes in neuroimaging), and radiologically isolated DS.

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“…Clinically, chorea in DS mostly involves the unilateral limbs, as in the case presented here, with only 9.7% bilateral involvement [ 9 ]. However, unlike the present case (who was fully asymptomatic before the stroke-like onset of chorea), prodromal symptoms are usually reported, including chest pain [ 22 ], shoulder pain [ 23 ], headaches [ 24 ], a gait imbalance [ 25 ], hemiparesis [ 26 ], lethargy [ 27 ], stiffness [ 28 ], vertigo [ 29 ], dizziness [ 20 , 30 ], confusion [ 31 ], and comas [ 10 ]. Moreover, the presentation of involuntary movements in DS may vary among patients; they could start abruptly (as described here) or insidiously (from a low to high amplitude) and manifest intermittently or continuously [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Diabetic Striatopathy: Parenchymal Transcranial Sonography as a Supplement to Diagnosis at the Emergency Department

Godani¹,

Lanza

2022

Diagnostics

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Background: Diabetic striatopathy (DS) is a rare condition with a debated pathophysiology; a local metabolic dysfunction is the most likely hypothesis. We present a case of DS mimicking an acute stroke, outline a few uncommon/atypical features, and report for the first time the parenchymal transcranial sonography (pTCS) findings. Case Report: An 86-year-old man, treated for insulin-dependent diabetes, presented at an emergency department because of the occurrence of isolated choreo-athetotic movements in his left limbs with fluctuations in the location, frequency, and duration. The blood glucose level was 569 mg/dL. Both urgent and follow-up brain computed tomography (CT) were negative for recent lesions whereas pTCS revealed hyperechogenicity in the right lenticular nucleus. Subsequent magnetic resonance imaging (MRI) showed T1-weighted hyperintensity in the right putamen with negative diffusion-weighted imaging. The symptoms were responsive to glucose control and haloperidol administration, although they persisted during sleep. Conclusions: Unlike previously described cases characterized by hemichorea and/or hemiballism, our patient presented with a stroke-like onset of unilateral irregular choreo-athetotic movements. Notably, based on CT alone, it would not have been possible to distinguish DS from a stroke. In this scenario, the pTCS hyperechogenicity of the right lenticular nucleus helped to hypothesize a metabolic disorder, which was subsequently confirmed by MRI.

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Non-ketotic hyperglycemia unmasks hemichorea

Cited by 11 publications

References 16 publications

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

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

Neuroimaging of Diabetic Striatopathy: More Questions than Answers

Diabetic Striatopathy: Parenchymal Transcranial Sonography as a Supplement to Diagnosis at the Emergency Department

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