“Dancing belly” in an old diabetic lady

Abstract

Movement disorder, although rare, is increasingly being recognized as the initial presenting sign of the hyperglycemic state. Although chorea-ballism has frequently been reported among diabetics, monoballism is a very rare phenomenon. While myoclonus is common, diaphragmatic myoclonus is extremely rare. Moreover, diaphragmatic myoclonus as the initial presenting manifestation has never been reported before. Herein, we report an index case of a 62-year-old previously undiagnosed diabetic lady presented with acute onset constellation of multiple abnormal movements viz. monoballism, focal myoclonus, action myoclonus, and diaphragmatic myoclonus. All of them disappeared with achieving normoglycemia. This case underscores the importance of rapid capillary blood glucose testing in any patient presenting with acute onset abnormal movements. This approach can especially be rewarding as it helps in the rapid diagnosis of a reversible catastrophe and avoiding unnecessary costly investigations.

Faciobrachial Myoclonus as the Presenting Manifestation of Diabetic Keto-Acidosis

“…Wernicke's encephalopathy with myoclonus Serum thiamine level was normal and brain MRI revealed no abnormality Anti-GAD antibody associated limb myoclonus with encephalopathy [17] Correction of hyperglycemia alone abated myoclonus obviating any need for steroids or immunotherapy Sporadic Creutzfeldt-Jakob disease Normal MRI brain and cerebrospinal fluid Table 1 Differential diagnoses of faciobrachial myoclonus. [2,8,9] or mediated by anti-GAD65 [17][18][19]. Anti-GAD-65 antibody, known to be pathophysiologically associated with a plethora of neurological manifestations, including myoclonus, probably did not play any role in our case as correction of hyperglycemia alone abated myoclonus obviating any need for steroids or immunotherapy [17].…”

“…As brain MRI showed no abnormality and functional neuroimaging and somatosensory evoked potential could not be done in our setup due to infrastructural limitations and COVID-19 regulations, exact localization (cortical or brainstem) and pathophysiological mechanism of myoclonus in this case remained unknown. In the present case, myoclonus could have occurred because of gamma-aminobutyric acid depletion that can be due to either hyperglycemia alone [ 2 8 9 ] or mediated by anti-GAD65 [ 17 18 19 ]. Anti-GAD-65 antibody, known to be pathophysiologically associated with a plethora of neurological manifestations, including myoclonus, probably did not play any role in our case as correction of hyperglycemia alone abated myoclonus obviating any need for steroids or immunotherapy [ 17 ].…”

“…Myoclonus among diabetic patients may generally occur in the setting of uremia, resulting from diabetic nephropathy [ 9 ], drug-toxicity [ 10 ], or in relation with some rare syndromes [ 11 ]. Dubey et al [ 2 ] reported a case of diaphragmatic and action myoclonus as the presenting feature of non-ketotic hyperglycemic state in a previously undiagnosed diabetic woman. Myoclonus as the presenting feature of diabetic amyotrophy has also been described [ 12 13 ].…”

“…The horizon of movement disorders in diabetes mellitus is expanding. While chorea and ballism are well-recognized acute potentially reversible movement disorders as the presenting manifestation of non-ketotic hyperglycemic states among older type-2 diabetics [ 1 ], different types of myoclonus are also being recently reported in this context [ 2 ]. We herein report the case of a 36-year-old previously healthy patient who presented with acute onset incessant faciobrachial myoclonus for 10 days.…”