Uncontrolled hyperglycaemia: a reversible cause of hemichorea–hemiballismus

Bhagwat, Nikhil M; Joshi, Ameya; Rao, Gururaja; Varthakavi, Premlata K

doi:10.1136/bcr-2013-010229

Cited by 15 publications

(15 citation statements)

References 5 publications

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“…Hemichorea-hemiballismus has also been reported in patients with HHS having long-standing poorly controlled diabetes mellitus and is attributed to the mild ischaemic changes in the distribution of lateral striate arteries which are branch of middle cerebral artery. The abnormal movement subsides after control of blood sugar and hyperosmolarity 7 . These lesions are non-enhancing and T1 hyperintense on MRI and hyperdense on CT scan 8 .…”

Section: Discussionmentioning

confidence: 99%

“…Low Glasgow Coma Scale (GCS) score, high plasma glucose and mild acidosis were predictors of mortality 4 . The neurological complications of HHS such as seizures, particularly partial seizures 5 6 , hyperkinetic movement disorders 7 and coma 3 , have been reported in isolated case reports or small case series. There is a paucity of studies reporting the spectrum of neurological manifestations of HHS and their outcome.…”

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confidence: 99%

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Spectrum of hyperosmolar hyperglycaemic state in neurology practice

Misra

Kalita

Bhoi

et al. 2017

Indian Journal of Medical Research

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Background & objectives:Hyperosmolar hyperglycaemic state (HHS) is a medical emergency, but there is a paucity of studies reporting the spectrum of neurological manifestations of HHS. We, therefore, report the neurological spectrum, triggering factors and outcome of HHS in general neurology practice.Methods:The records of the patients with HHS were extracted from computerized hospital information system and those managed currently were prospectively included. The demographic, clinical manifestations, duration of diabetes and precipitating events such as infection, stress and stroke were noted. Patients with HHS were categorized into seizure, movement disorder and encephalopathy groups. Their electroencephalography, magnetic resonance imaging (MRI) findings and outcome were noted.Results:There were 17 patients with HHS (age range 40 and 75 yr) and seven were females. Seven patients were diabetic for five years, one for four years, one for one year and four were diagnosed after the occurrence of HHS. Four patients had epilepsia partialis continua persisting for 72-360 h, one patient had focal seizures and his MRI revealed T2 hyperintensity in frontal region in one patient and cerebellar vermian hyperintensity in another. All the five patients improved, but two had neurological deficits on discharge. Nine patients had encephalopathy which was precipitated by stroke in six patients, urinary infections in two and meningitis in one. Three females had hemichorea-hemiballismus syndrome, which was triggered by infections. Abnormal movements lasted 5-10 days and responded to correction of hyperosmolarity. Nine out of 17 patients improved completely whereas the remaining eight had partial recovery, these patients had stroke, ventilator-related complications or meningoencephalitis.Interpretation & conclusions:The most common presentation of HHS was encephalopathy (9) followed by seizure (5) and hemichorea-hemiballismus syndrome (3) which responded to the correction of hyperosmolar state.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Spectrum of hyperosmolar hyperglycaemic state in neurology practice

Misra

Kalita

Bhoi

et al. 2017

Indian Journal of Medical Research

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“…Hyperglycaemic chorea was described for the first time by Bedwell in 1960. He analysed 53 cases with mean of age 71 years who were predominantly Asian women, suggesting a genetic predisposition [4] .…”

Section: Discussionmentioning

confidence: 99%

Hyperglycaemic Hemichorea

Marques

Monteiro

Nunes

et al. 2018

European Journal of Case Reports in Internal Medicine

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BackgroundHyperkinetic disorders such as hemichorea can be caused by cerebrovascular, infectious or inflammatory diseases or by metabolic conditions such as hyperglycaemia. Hyperglycaemic hemichorea is a rare movement disorder which is frequently misdiagnosed. It is characterized by involuntary, continuous, non-patterned movements on one side of the body, basal ganglia lesions seen on head CT or MRI, and clinical improvement after blood glucose normalization. We describe the case of a female patient with uncontrolled diabetes who presented with hemichorea.Case presentationWe report the case of a 69-year-old woman with type 2 diabetes who presented with abnormal movements of the right upper limb. She had no neurological signs other than hemichorea. Her blood glucose level was 349 mg/dl and her glycosylated haemoglobin level (HbA1c) was 10.5%. Head CT and MRI showed no changes in the basal ganglia or ischaemic lesions. The patient was started on insulin and haloperidol with clinical improvement.ConclusionLarger case series are needed to establish better understanding of the physiopathological mechanisms and diagnostic criteria of hyperglycaemic hemichorea. The most important diagnostic criterion is clinical improvement after glycaemic control.LEARNING POINTSHyperglycaemia is a rare cause of hemichorea.Better understanding of the physiopathology and the establishment of diagnostic criteria are required.Correction of the underlying hyperglycaemia will lead to rapid improvement of the movements and is the most important feature for diagnosis.

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“…The differential diagnoses that should be considered are: medication use, specially levodopa and hormone replacement therapy (estrogens); genetic causes like Wilson's disease and Huntington's chorea in young patients; infectious causes such as post-streptococcal Sydenham's chorea, human immunodeficiency virus infection; metabolic causes like hyperthyroidism and lastly antiphospholipid syndrome and carbon monoxide poisoning [ 4 - 5 ].…”

Section: Discussionmentioning

confidence: 99%

New-Onset Diabetes Presenting as Monoballism Secondary to a Mixed Hyperglycemic Crisis

García‐Grimshaw¹,

Jiménez‐Ruiz

Ornelas-Velazquez

et al. 2018

Cureus

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Monoballism secondary to a mixed hyperglycemic crisis is a rare initial symptom of new-onset diabetes, which commonly affects the elderly and Asian women having inadequate glycemic control. In hyperglycemic states, the elevated serum glucose levels raise the viscosity of the blood reducing cerebral perfusion, decreasing gamma-aminobutyric acid levels, the latter being an inhibitory neurotransmitter of thalamocortical stimuli. In this case, we report a previously healthy 41-year-old male who attended the emergency department because of an abrupt onset movement disorder of the left arm, this being compatible with monoballism. He was diagnosed with a mixed hyperglycemic crisis.

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Uncontrolled hyperglycaemia: a reversible cause of hemichorea–hemiballismus

Cited by 15 publications

References 5 publications

Spectrum of hyperosmolar hyperglycaemic state in neurology practice

Spectrum of hyperosmolar hyperglycaemic state in neurology practice

Hyperglycaemic Hemichorea

New-Onset Diabetes Presenting as Monoballism Secondary to a Mixed Hyperglycemic Crisis

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