Diabetic hemichorea-hemiballismus with nonketotic hyperglicemia: a rare cause of hyperkinetic movement disorders

Abstract

A 67-year-old woman was admitted with right hemichorea-hemiballismus. Blood glucose: 831 mg/dl. Magnetic resonance imaging (MRI) showed signal change in the left striatum (Figures 1 and 2). This entity is characterized by hyperintensity confined to the striatum on T1-weighted MRI and contralateral hyperkinetic movement disorders in diabetic patients (type 2) with non-ketotic hyperglycemia 1. T2*-weighted gradient-echo MRI can reveal low signal intensity related to petechial hemorrhage 2. Pathological studies demonstrated selective neuronal loss, gliosis, reactive astrocytosis and hemorrhage 3. The clinical symptoms usually improve markedly following the correction of hyperglycemia. Thus, the prompt recognition of this potentially treatable disease is of paramount importance.