Faciobrachial Myoclonus as the Presenting Manifestation of Diabetic Keto-Acidosis

Abstract

Background: 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. Myoclonus as the form of presentation of diabetic keto-acidosis (DKA) in previously undiagnosed type-1 diabetic has never been reported before. Case report: We herein report the case of a 36-year-old previously healthy patient who presented with acute onset incessant faciobrachial myoclonus for 10 days. The patient was found to be suffering from DKA and eventually diagnosed as type-1 diabetes mellitus. Myoclonus disappeared with achieving euglycemia and did not recur. Discussion: Apart from expanding the spectrum of acute movement disorder among diabetics, this case reiterates the importance of rapid bedside measurement of capillary blood glucose in all patients presenting with acute onset abnormal movements irrespective of their past glycemic status. This simple yet life-saving approach can clinch the diagnosis at the earliest and thus will avoid costly investigations and mismanagement.

Acute onset movement disorders in diabetes mellitus: A clinical series of 59 patients

“…Previous clinical series and systematic review regarding acute onset movement disorders in diabetes mellitus (DM) included only patients with chorea or ballism (Table 1) [1][2][3][4][5][6][7][8][9][10]. However, in the past few years, different case reports describing other movement disorders apart from chorea and ballism have been reported [13][14][15][16].…”

Hemifacial Spasm as the Presenting Manifestation of Type 3c Diabetes Mellitus

“…Acute to subacute onset movement disorders (mostly chorea and ballism) as the presenting feature of nonketotic and ketotic hyperglycemic complications (mostly among type-2 diabetics) are well recognized in the literature [4,5]. With simple correction of the hyperglycemic state, these movements usually subside [4,5]. However, hyperglycemia-associated hemifacial spasm in T3cDM has not been previously reported.…”

Recurrent Facial Focal Seizures With Chronic Striatopathy and Caudate Atrophy—A Double Whammy in an Elderly Woman With Diabetes Mellitus

“…This index case was unique because of the coexistence of 2 rare neurological manifestations of DM in a patient at the No obvious peri-lesional edema is noted. Curvilinear blooming in the spaceoccupying lesion is noted on gradient-recalled-echo (4); however, no evidence of restricted diffusion on diffusion-weighted imaging is observed (5). On post-contrast T1-weighted imaging, the spaceoccupying lesion shows irregular peripheral enhancement (6).…”

“…It is well-recognized that diabetes mellitus (DM), particularly when associated with non-ketotic hyperglycemia (NKH), can present with seizures. [1][2][3] On the other hand, DM is associated with a plethora of involuntary movements, [4][5][6] most commonly hemichorea-hemiballism (HCHB), termed as diabetic striatopathy (DS). 7 Both of these disorders are frequently reversible with rapid correction of metabolic perturbations caused by hyperglycemia, with others some requiring anti-epileptics and/or neuroleptics.…”

“…Areas of chronic small vessel ischemic changes are also noted in the periventricular white matter (3) (yellow arrows). Notice severely atrophied left caudate nucleus (black arrow) and significantly dilated frontal horn of left lateral ventricle(5).…”