Chorea, Ballism, and Athetosis

Cardoso, Francisco

doi:10.1007/978-3-7091-1628-9_26

Cited by 2 publications

(3 citation statements)

References 65 publications

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“…6 When choreic movements are more severe, assuming a flinging, flailing character, it is termed ballism. 7 As sudden onset hemichorea, hemiballism, or hemiathetosis appear to share a common anatomic location for the lesion, it was proposed that these movement disorders represent degrees of severity of the same pathology. 3,8 Therefore, the term HCHB is used to denote a hyperkinetic movement disorder seen in patients with acute or subacute onset of involuntary movements affecting one side of the body.…”

Section: Discussionmentioning

confidence: 99%

Hemichorea-Hemiballism in A 50-Year-Old Man With Newly Diagnosed Diabetes

Hasan

Atiqur-Rahman

Chowdhury

2021

AACE Clinical Case Reports

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Objective: Hyperglycemia may cause acute central nervous system dysfunction manifesting as agonizing involuntary movements due to insult to the basal ganglia. We report a case of hemichorea-hemiballism (HCHB) in a patient with diabetes. Method: Clinical assessment of the patient was performed, along with laboratory tests and brain imaging. Results: The patient was a 50-year-old man with newly detected diabetes with persistent involuntary movement of the right upper and lower limbs for few weeks. The involuntary movement was nonrhythmic, nonpatterned, purposeless, and often jerky with variable amplitude and frequency, sometimes wild and flailing in the form of hemichorea with a ballistic component (HCHB). He had a history of poor compliance to prescribed oral antidiabetic drugs. At presentation, although he was hemodynamically stable, random capillary blood glucose level was 18 mmol/L and glycated hemoglobin A1 level was 15.1% (141.5 mmol/mol). Clinical examination did not reveal any focal deficit or positive Babinski sign. There was a hyperintensity in the left basal ganglia region in T1-weighted magnetic resonance imaging (MRI) of the brain, which was iso-to-hyperintense in T2-weighted image and fluid-attenuated inversion recovery sequence. There was no restriction of diffusion on the diffusion-weighted image or blooming on gradient echo sequences, indicating absence of infarction or hemorrhage. Control of hyperglycemia resulted in disappearance of the involuntary movement within 1 month. Conclusion: While there are many differential diagnoses for HCHB, the clinical scenario suggests hyperglycemia as the underlying cause in this patient. This case reiterates that multiple central nervous system manifestations may be attributable to diabetes.

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Section: Discussionmentioning

confidence: 99%

Hemichorea-Hemiballism in A 50-Year-Old Man With Newly Diagnosed Diabetes

Hasan

Atiqur-Rahman

Chowdhury

2021

AACE Clinical Case Reports

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“…When they are more severe and violent, they are referred to as ballism. As opposed to the usual distal and low-amplitude contractions in chorea, ballism movements are more ample and proximal [ 1 , 2 ]. Non-genetic chorea can be divided into different etiological types: vascular, autoimmune, drug-induced, metabolic, and infectious [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…As opposed to the usual distal and low-amplitude contractions in chorea, ballism movements are more ample and proximal [ 1 , 2 ]. Non-genetic chorea can be divided into different etiological types: vascular, autoimmune, drug-induced, metabolic, and infectious [ 1 , 2 ]. Severe non-ketotic hyperglycemia is a rare cause of metabolic hemichorea or hemiballismus, most commonly found in poorly controlled elderly diabetic patients.…”

Section: Introductionmentioning

confidence: 99%

Hyperglycemic Hemichorea: A Case Report

Lopes¹,

Antunes²,

Oliveira³

et al. 2023

Cureus

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Chorea is a hyperkinetic movement disorder characterized by a continuous flow of rapid, random, and involuntary bodily contractions, usually affecting the distal limbs. When these movements are more proximal or assume a larger amplitude with a flinging or kicking character, they’re referred to as ballism. These disorders can be associated with several causes, ranging from genetic and neurovascular to toxic, autoimmune, and metabolic. Non-ketotic hyperglycemic hemichorea-hemiballismus is a rare consequence of decompensated diabetes mellitus with a poorly understood pathogenesis but with characteristic MRI T1 and T2 hyperintense abnormalities in the contralateral basal ganglia. We present the case of a 74-year-old woman with a history of poorly controlled type 2 diabetes mellitus, dyslipidemia, and arterial hypertension who was admitted to the emergency room due to a two-day history of rapid non-stereotypical involuntary movements of the left side of her body. A neurological exam showed large amplitude and repetitive left-side body movements. Glycemia was 541 mg/dL with no ketosis. Her glycosylated hemoglobin was 14%. A brain CT excluded acute abnormalities. Brain MRI showed a discrete T1 hyperintense signal involving the right corpus striatum, compatible with non-ketotic hyperglycemic hemichorea-hemiballism syndrome. After metabolic optimization with insulin and haloperidol, the movements resolved. Early recognition and metabolic control are essential to the resolution of choreiform movements. Our aim is to raise awareness for hyperglycemic hemichorea-hemiballismus, in which decompensated diabetes is the early sign of diagnosis.

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Chorea, Ballism, and Athetosis

Cited by 2 publications

References 65 publications

Hemichorea-Hemiballism in A 50-Year-Old Man With Newly Diagnosed Diabetes

Hemichorea-Hemiballism in A 50-Year-Old Man With Newly Diagnosed Diabetes

Hyperglycemic Hemichorea: A Case Report

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