Clinical Reasoning: A 52-year-old woman with subacute hemichorea

Involuntary movements in an elderly woman with recently diagnosed diabetes

“…3 of Images in Neuroscience: Question) and DWI were hypointense; in hyperglycaemia-induced choreoathetosis/ballism, findings on T2-weighted and DWI sequences are variable, and depend on the time at which imaging is performed. [1][2][3][4][5] There was no evidence of petechial hemorrhage on GRE images. 3,5 This syndrome can complicate long-standing type 1 or type 2 diabetes, and has also been described as a presenting symptom of diabetes.…”

Hyperglycemia-Induced Hemiballismus Hemichorea: A Case Report and Brief Review of the Literature

“…Younger patients may be manifesting an inheritable cause like Wilson's disease or Huntington's chorea. Other causes that may need to be ruled out in the relevant clinical setting include post-streptococcal Sydenham's chorea, human immunodeficiency virus (HIV), hyperthyroidism, antiphospholipid syndrome, and carbon monoxide poisoning (5).…”

Hemichorea: A Rare Neurological Deficit in the Emergency Department

“…Particularly, Huntington's disease and the genetic syndromes may resemble it, and brain iron accumulation disorders, Wilson's disease, benign hereditary chorea, Friedreich ataxia, and mitochondrial disease are the inherited causes. Acquired causes of hemichorea include vascular diseases, post-infective central nervous system diseases, drugs such as those associated with levodopa or with estrogen replacement therapy, systemic lupus erythematosus, antiphospholipid syndrome, thyrotoxicosis, human immunodeficiency virus infection, chorea gravidarum, and polycythemia rubra vera (2,3). Major causes of hemichorea include hemorrhagic or ischemic stroke, metastasis, non-ketotic hyperglycemia, complication of ventriculoperitoneal shunt, and nutritional vitamin D deficiency (4)(5)(6)(7).…”