Hemichorea Associated With Non-ketotic Hyperglycemia: A Case Report and Literature Review

Abstract

Objective: To explore the clinical manifestation, diagnosis, therapy, and mechanism of hemichorea associated with non-ketotic hyperglycemia (HC-NH) so as to enhance awareness and avoid misdiagnosis or missed diagnosis of the disease. Methods: A case of HC-NH was reported and reviewed in terms of the clinical features, diagnosis and treatment. Results: Hemichorea associated with non-ketotic hyperglycemia is a rare complication of diabetes mellitus, which is commonly seen in elderly women with poorly-controlled diabetes. The condition is characterized by non-ketotic hyperglycemia, unilateral involuntary choreiform movements, and contralateral basal ganglia hyper-intensity by T1-weighted MR imaging or high density on CT scans. Blood glucose control is the basal treatment, in combination with dopamine receptor antagonists and benzodiazepine sedative, in controlling hemichorea. Conclusion: In clinical practice, the possibility of unilateral chorea should be considered for diabetic patients with poor blood glucose control.

Non-ketotic Hyperglycemia Chorea-Ballismus and Intracerebral Hemorrhage: A Case Report and Literature Review

“…The features of neuroimaging are the reversible hyperdense and hyperintense lesions limited to the contralateral striatum areas of the affected limbs without edema and mass effect, on CT and T1-weighted sequences magnetic resonance imaging (MRI), respectively (Oh et al, 2002 ). The radiological findings can be variable signals on T2-weighted, diffusion-weighted imaging, and fluid-attenuation inversion recovery sequences of MRI, and no enhancement on an enhanced scan (Chu et al, 2002 ; Oh et al, 2002 ; Zheng et al, 2020 ). Despite the highly significant correlation between CT and MRI findings, the recent study has shown that there is about one-sixth mismatch and incompatibility between CT and MRI results.…”

“…Some histological studies have found that the hyperdense striatal lesions were usually characterized by gliosis, selective neuronal loss, and reactive astrocytes rather than the evidence of hemorrhage or infarction within these areas (Shan et al, 1998 ; Lee et al, 2002 ; Cherian et al, 2009 ). Of course, if conditions permit, MRI remains an essential method helpful in not only diagnosis but also judging prognosis (by the value of apparent diffusion coefficient maps) (Chu et al, 2002 ; Zheng et al, 2020 ). Selected other causes of hyperdense/hyperintense striatal region on CT or T1-weighted MRI should be also considered for the initial visit ( Table 3 ).…”

Chorea in a diabetic patient with poor metabolic control

“…Type 2 diabetes mellitus is one of the highest-incidence diseases worldwide, presenting multiple complications in different organs and systems, such as in the nervous system, both peripheral and central. [1][2][3][4][5][6] The case we present is chorea, which is associated with poor metabolic control. 7 It manifests clinically with movement disorders, such as hemichorea or hemiballism.…”

Non-Ketotic Hyperglycemic Hemichorea-Hemiballismus in the Setting of Antipsychotics and Methamphetamine

“…Hemichorea associated with non-ketotic hyperglycemia (HC-NH) is a rare complication of diabetes mellitus, especially in patients that do not control their diabetes properly. The pathophysiology of this disease is not well known but chorea symptoms resolve with control over the hyperglycemia and resolve while sleeping [ 15 ]. Other causes of hemichorea-hemiballism include ischemic and hemorrhagic strokes, drugs, motor neuron disease, neurodegenerative diseases, and autoimmune disorders [ 16 ].…”

“…Hemichorea can result from pharmacological agents, in this case, both second-generation antipsychotics and methamphetamine are present and are potential contributors to our patient's presentation. In this case report, we describe a non-ketotic hyperglycemic hemichorea-hemiballismus with other potential secondary etiologies also present [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16].…”