Hemichorea–hemiballism: a case report

Patel, Bhavini; Ladva, Zeena R

doi:10.1136/practneurol-2014-001063

Cited by 10 publications

(4 citation statements)

References 2 publications

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“…Clinically, chorea in DS mostly involves the unilateral limbs, as in the case presented here, with only 9.7% bilateral involvement [ 9 ]. However, unlike the present case (who was fully asymptomatic before the stroke-like onset of chorea), prodromal symptoms are usually reported, including chest pain [ 22 ], shoulder pain [ 23 ], headaches [ 24 ], a gait imbalance [ 25 ], hemiparesis [ 26 ], lethargy [ 27 ], stiffness [ 28 ], vertigo [ 29 ], dizziness [ 20 , 30 ], confusion [ 31 ], and comas [ 10 ]. Moreover, the presentation of involuntary movements in DS may vary among patients; they could start abruptly (as described here) or insidiously (from a low to high amplitude) and manifest intermittently or continuously [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Diabetic Striatopathy: Parenchymal Transcranial Sonography as a Supplement to Diagnosis at the Emergency Department

Godani¹,

Lanza

2022

Diagnostics

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Background: Diabetic striatopathy (DS) is a rare condition with a debated pathophysiology; a local metabolic dysfunction is the most likely hypothesis. We present a case of DS mimicking an acute stroke, outline a few uncommon/atypical features, and report for the first time the parenchymal transcranial sonography (pTCS) findings. Case Report: An 86-year-old man, treated for insulin-dependent diabetes, presented at an emergency department because of the occurrence of isolated choreo-athetotic movements in his left limbs with fluctuations in the location, frequency, and duration. The blood glucose level was 569 mg/dL. Both urgent and follow-up brain computed tomography (CT) were negative for recent lesions whereas pTCS revealed hyperechogenicity in the right lenticular nucleus. Subsequent magnetic resonance imaging (MRI) showed T1-weighted hyperintensity in the right putamen with negative diffusion-weighted imaging. The symptoms were responsive to glucose control and haloperidol administration, although they persisted during sleep. Conclusions: Unlike previously described cases characterized by hemichorea and/or hemiballism, our patient presented with a stroke-like onset of unilateral irregular choreo-athetotic movements. Notably, based on CT alone, it would not have been possible to distinguish DS from a stroke. In this scenario, the pTCS hyperechogenicity of the right lenticular nucleus helped to hypothesize a metabolic disorder, which was subsequently confirmed by MRI.

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Section: Discussionmentioning

confidence: 99%

Diabetic Striatopathy: Parenchymal Transcranial Sonography as a Supplement to Diagnosis at the Emergency Department

Godani¹,

Lanza

2022

Diagnostics

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“…The imbalanced GABA system and vascular insufficiency could further contribute to movement disorder. The hyperglycemic state promotes deposition of a T1-intense mineral, such as calcium or manganese and recovered after glucose normalized [15].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Hemichorea-Hemiballism between Acute Stroke and Nonketotic-Hyperglycinemia in the Clinical Scenario: Report of a Rare Diabetic Complication

et al. 2019

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Diabetes mellitus is the major cause of retinopathy, nephropathy and neuropathy. Hyperglycemia is one of major major advised effect on diabetes mellitus. Hemichorea-hemiballism, a rare manifestation of nonketotic hyperglycemia, characterized by involuntary arrhythmic motions in one side of the body which results from focal lesions in the contralateral basal ganglia. Here, we present a 39-year-old woman with violent involuntary rapid and irregular movements of left limbs three days prior to emergency department. Nonketotic hyperglycemia related hemichorea-hemiballism had been confirmed by biochemistry examination and brain computed tomography (CT). Aggressive glucose control with insulin was administered. Her symptoms got improvement gradually after euglycemia two weeks later.

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“…Clinical symptoms usually take approximately five to six months to resolve after the hyperglycemia is controlled. [16–18] Therefore, the most important treatment for diabetic non-ketotic hemichorea-hemiballism is the achievement of appropriate blood glycemic control. Dopamine receptor antagonists and GABA A receptor agonists can be used to control these movement disorders.…”

Section: Discussionmentioning

confidence: 99%

“…The hyperglycemic state promotes deposition of a T1-intense mineral, such as calcium or manganese, which recovers after glucose is normalized. [16–18] Only a few case reports with negative imaging have been reported. [14,19,20]…”

Section: Discussionmentioning

confidence: 99%

Investigation of the relationship between non-ketotic hyperglycemia and hemichorea-hemiballism

Hsiao

Kuo

et al. 2019

Medicine

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Rationale: Hemichorea-hemiballism, a rare manifestation of non-ketotic hyperglycemia, characterized by involuntary arrhythmic motions involving one side of the body, results from focal lesions in the contralateral caudate nucleus and putamen. Hyperkinetic disorders can be complications of uncontrolled diabetes mellitus and should not be ignored. Patient concerns: We present the case of a 39-year-old woman who presented to the emergency department with a 3-day history of left-sided hemichorea-hemiballism. She had type 2 diabetes mellitus with poor control and maintenance of regular hemodialysis. Diagnoses: The patient was diagnosed as hyperglycemia, normal ketone body and hemichorea-hemiballism based on laboratory examination, computed tomography (CT) scan, and brain magnetic resonance image (MRI). Interventions: Intensive glycemic control via insulin injection was prescribed for correction of hyperglycemia. Outcomes: The unilateral involuntary movements subsided progressively over four weeks. The patient's hemichorea had completely resolved at the three-month follow-up. Lessons: This unusual clinical presentation is often accompanied by severe hyperglycemia. Appropriate blood glycemic control is important. If physicians recognize and provide early treatment for this disease, it is usually treatable and has a good prognosis.

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Hemichorea–hemiballism: a case report

Cited by 10 publications

References 2 publications

Diabetic Striatopathy: Parenchymal Transcranial Sonography as a Supplement to Diagnosis at the Emergency Department

Diabetic Striatopathy: Parenchymal Transcranial Sonography as a Supplement to Diagnosis at the Emergency Department

Comparison of Hemichorea-Hemiballism between Acute Stroke and Nonketotic-Hyperglycinemia in the Clinical Scenario: Report of a Rare Diabetic Complication

Investigation of the relationship between non-ketotic hyperglycemia and hemichorea-hemiballism

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