Hemichorea-hemiballismus as a rare presentation of non-ketotic hyperglycemia: a case report

Authors

  • Vijay Kumar Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Patna, Bihar, India http://orcid.org/0000-0001-6042-7784
  • Kotha Vamshi Krishna Patel Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Patna, Bihar, India
  • Rishav Raj Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Patna, Bihar, India
  • Divendu Bhushan Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Patna, Bihar, India
  • Aniketh V. Hegde Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Patna, Bihar, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20220419

Keywords:

Hemichorea-hemiballismus, Nonketotic hyperglycemia, Diabetic striatopathy

Abstract

Hemichorea-hemiballismus is a hyperkinetic movement disorder on one side of the body resulting from involvement of the contralateral basal ganglia and striatum mainly. A 50-year-old female presented with a 5-days history of choreiform movements affecting the left upper and lower limb along with hemiface. Her plasma glucose was 576 mgl/dl and her urinary ketones were negative suggesting non-ketotic hyperglycemia. Computed tomography revealed hyper-density in right caudate and putamen consistent with diabetic striatopathy. Non-ketotic hyperglycemia is a rare cause of hemichorea-hemiballismus syndrome. Hemichorea-hemiballismus can be an unusual and rare presentation of diabetic elderly population especially females. Early diagnosis and treatment of hyperglycemia yields an excellent prognosis.

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Author Biography

Vijay Kumar, Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Patna, Bihar, India

ASSOCIATE PROFESSOR,DEPARTMENT OF GENERAL MEDICINE,ALL INDIA INSTITUTE OF MEDICAL SCIENCES(AIIMS),PATNA, BIHAR, INDIA

References

Oh SH, Lee KY, Im JH, Lee MS. Chorea associated with non-ketotic hyperglycemia and hyperintensity basal ganglia lesion on T1-weighted brain MRI study: a meta-analysis of 53 cases including four present cases. J Neurol Sci. 2002;200(1):57-62.

Roy U, Das SK, Mukherjee A, Biswas D, Pan K, Biswas A, et al. Irreversible Hemichorea–Hemiballism in a Case of Nonketotic Hyperglycemia Presenting as the Initial Manifestation of Diabetes Mellitus. Tremor Hyperkinetic Mov. 2016;6. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5019112/. Accessed on 23 May 2021.

Ohara S, Nakagawa S, Tabata K, Hashimoto T. Hemiballism with hyperglycemia and striatal T1-MRI hyperintensity: An autopsy report. Mov Disord. 2001;16(3):521-5.

Chorea-ballismus with nonketotic hyperglycemia in primary diabetes mellitus. | American Journal of Neuroradiology. 2021. Available at: http://www.ajnr.org/content/17/6/1057.short. Accessed on 23 May 2021.

Qi X, Yan Y, Gao Y, Zheng Z, Chang Y. Hemichorea associated with non-ketotic hyperglycaemia: A case report. Diabetes Res Clin Pract. 2012;95(1):e1-3.

Crausman RS, Wen J, Al-Shalabi S. Choreoathetosis and Diabetes. Diabetes Care. 1997;20(7):1209-10.

Higa M, Kaneko Y, Inokuchi T. Two cases of hyperglycemic chorea in diabetic patients. Diabet Med. 2004;21(2):196-8.

Ray S, Howlader S, Chakraborty S, Chakraborty PP, Ghosh S. Hemichorea-Hemiballism as the First Presentation of Type 2 Diabetes. Clin Diabetes. 2015;33(2):87-9.

Lk S, Ak M, G M, Kp S, Sk S. Hemichorea Secondary to Non-Ketotic Hyperglycemia as the Presenting Manifestation of Diabetes Mellitus. J Assoc Physicians India. 2020;68(2):82-3.

Lee SH, Shin JA, Kim JH, Son JW, Lee KW, Ko SH et al. Chorea-ballism associated with nonketotic hyperglycaemia or diabetic ketoacidosis: Characteristics of 25 patients in Korea. Diabetes Res Clin Pract. 2011;93(2):e80-3.

Felicio AC, Chang CV, Godeiro-Junior C, Okoshi MP, Ferraz HB. Hemichorea-hemiballism as the first presentation of type 2 diabetes mellitus. Arq Neuropsiquiatr. 2008;66(2A):249-50.

Hemichorea-hemiballism: an explanation for MR signal changes. American Journal of Neuroradiology. Available at: http://www.ajnr.org/content/19/5/863.short. Accessed on 23 May 2021.

Unilateral Putaminal CT, MR, and Diffusion Abnormalities Secondary to Nonketotic Hyperglycemia in the Setting of Acute Neurologic Symptoms Mimicking Stroke. American Journal of Neuroradiology. Available at: http://www.ajnr.org/content/25/6/975.short. Accessed on 23 May 2021.

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Published

2022-02-23

How to Cite

Kumar, V., Patel, K. V. K., Raj, R., Bhushan, D., & Hegde, A. V. (2022). Hemichorea-hemiballismus as a rare presentation of non-ketotic hyperglycemia: a case report. International Journal of Basic & Clinical Pharmacology, 11(2), 181–184. https://doi.org/10.18203/2319-2003.ijbcp20220419

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Section

Case Reports