Rare and Reversible cause of hemichorea-hemiballismus
- Non ketotic hyperglycemia
Dr.K.Subhashini
Govt.Kilpauk Medical College Hospital,Chennai
Introduction
A case of a postmenopausal woman with a non ketotic hyperglycemia
induced hemichorea-hemiballismus
Case report :
• An 81 year-old postmenopausal woman presented with violent flinging
involuntary movements involving the right upper and lower limb for a
period of about 10days.
• Diabetic for 20 years on oral medications.
• Her random blood glucose value - 471 mg/dl
• HbA1c was 10.1%.
• Urine examination was negative for ketones
• ABG values - within normal limits. Rest of the blood tests were normal
with no obvious electrolyte imbalances.
• Free Thyroid profile imbalance- normal.
• MRI BRAIN - T1 weighted MRI of the brain showed hyperintense
changes in the contralateral lentiform nucleus.
• Based on the clinical presentation, laboratory investigations and MRI
findings a diagnosis of Non ketotic hyperglycemic hemichorea-
hemiballismus-syndrome was made.
She was treated for adequate glycemic control with insulin.
Haloperidol 0.5 mg bd was given and her involuntary
movements slowly settled over 1 week.
Conclusion:
•  Nonketotic hyperglycemia is an unusual but important
differential diagnosis in patients with hemichorea-
hemiballismus as prompt diagnosis and treatment of
hyperglycemia has an excellent prognosis.
• As demonstrated in our case, hemichorea-hemiballismus
can occur after years of poor glycemic control or may be
the first manifestation of decompensated diabetes
mellitus .
• The pathogenesis is thought to be related to
hyperglycemia-induced perfusion changes in the
contralateral striatum and ischemic excitotoxicity of
GABAergic neurons. This results in excessive inhibition of
the subthalamic nuclei and excitatory cortical output.
• All patients with this clinical presentation should be
screened for diabetes and known diabetics should be