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

Narayanan, Shivakumar

doi:10.1016/j.jemermed.2010.05.003

Cited by 36 publications

(29 citation statements)

References 7 publications

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“…Hyperglycemia and hyperosmolarity can lead to hyperviscosity, resulting in ischemia and disruption of the blood-brain barrier, causing intracellular acidosis and regional metabolic failure (12,13) as demonstrated by magnetic resonance spectroscopy (14). The hypoxemicischemic damage induces metabolic derangements that can further worsen clinical manifestations (13,15).…”

Section: Discussionmentioning

confidence: 99%

Hyperglycemia-Induced Involuntary Movements: 2 Case Reports and a Review of the Literature

Borensztein

Walker

Schell

et al. 2015

AACE Clinical Case Reports

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Objective: Autonomic and peripheral neurologic manifestations of hyperglycemia are commonly seen in clinical practice; acute hyperglycemia-induced involuntary movements (HIIM) are rarer and less well known. In this article we describe 2 patients with HIIM and review the scientific literature to better characterize the clinical and pathophysiologic features of these disorders.Methods: A literature search was performed using the PubMed database. Whenever possible, the most recent publication on a topic was utilized, with a 20-year cutoff time since publication. Articles were selected based on the quality of presented data or citations utilized.Results: HIIM can present in a variety of ways including seizures, hemichorea-hemiballismus (HCHB) and, very rarely, tremor. While HIIM are more commonly seen in patients with long-standing, uncontrolled diabetes, they can also be the initial presentation of diabetes. The precise pathophysiology of HIIM remains unknown; however, at least for HCHB, it is hypothesized that hyperglycemia increases the metabolism of the inhibitory neurotransmit-Abbreviations: HCHB = hemichorea-hemiballismus; HIIM = hyperglycemia-induced involuntary movements; GABA = gamma aminobutyric acid; EPC = epilepsia partialis continua; MRI = magnetic resonance imaging; NKH = nonketotic hyperglycemia

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Section: Discussionmentioning

confidence: 99%

Hyperglycemia-Induced Involuntary Movements: 2 Case Reports and a Review of the Literature

Borensztein

Walker

Schell

et al. 2015

AACE Clinical Case Reports

View full text Add to dashboard Cite

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“…(2) The exact clinical pathophysiology of hyperglycaemiainduced chorea-hemiballismus is poorly understood. Postulated mechanisms include: (3) (a) hyperglycaemia and associated hyperviscosity, which can disrupt the blood-brain barrier, leading to intracellular acidosis and regional metabolic failure; (b) petechial haemorrhage or striatal infarction; (c) an increase in sensitivity of dopamine receptors during the postmenopausal period, possibly triggering hyperkinesis in an appropriate setting; and (d) decreased thalamic or striatum gamma-aminobutyric acid (GABA) due to lack of acetoacetate for GABA conversion in a nonketotic state. In our patient, MR imaging of the brain revealed only T1 hyperintense signal changes in the right putamen.…”

Section: Discussionmentioning

confidence: 99%

Clinics in diagnostic imaging (166)

Goh

Chinchure

Lim

2016

smedj

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A 68-year-old diabetic Malay woman presented to the emergency department with choreoathetoid movements that initially affected the upper left limb and subsequently progressed to the lower left limb over three days. This was not associated with any other neurological symptoms such as slurring of speech, limb weakness or numbness. Clinical examination revealed upper and lower left limb choreoathetoid movements with no limb weakness, facial asymmetry, nystagmus or other cerebellar signs. Her venous blood glucose level was elevated at 23.3 mmol/L. Unenhanced computed tomography (CT) of the brain (Fig. 1a) and subsequent magnetic resonance (MR) imaging of the brain (Figs. 1b-d) were performed according to the department's stroke protocol. What do these images show? What is the diagnosis?

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“…Hyperglycemia associated with ballismus/chorea (HABC) is commonly seen in patients with DM aged between 50-80 years, whose blood glucose levels cannot be regulated (19,20). Typically, the clinical picture settles within hours.…”

Section: Discussionmentioning

confidence: 99%

Hemichorea and Hemiballismus Associated with Cerebral Vascular Malformation Induced by Hyperglycemia: Case Report

Selçuk¹,

Sorgun²,

Akpınar³

2016

tnd

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Hemichorea, hemiballismus, and hyperglycemia associated with vascular malformation is rare. We report a patient who presented with involuntary movements in the left-side with concurrent hyperglycemia. The patient had type 2 diabetes mellitus (DM) and a venous angioma in the basal ganglia on the cranial magnetic resonance imaging (MRI). A woman aged 49 years presented with flinging and throwing movements of the left upper and lower limb, which she had had for one month. Her neurologic examination confirmed involuntary, irregular, wide amplitude movements of the left limbs consistent with left hemiballismus. She had hypertension and type 2 DM. Her glucose level was 400 mg/dL. Cranial MRI showed a cavernoma in the right subependymal area of the lateral ventricle and a venous angioma in the right nucleus lentiformis, which was confirmed on digital subtraction angiography. Hemiballismus improved after blood glucose level had been regulated in the follow-up period. Especially in the elderly secondary causes should be investigated in patients with acute or subacute onset of choreaballismus. We think that our patient's clinical presentation was induced by unregulated DM. Venous angioma with chorea-ballismus is rarely stated in literature and we presume the mass effect of venous angioma could be responsible of our clinical findings. Keywords: Chorea, ballismus, vascular malformation, hyperglycemiaVasküler malformasyona bağlı hemiballizm, hemikore ve hiperglisemi birlikteliği olgusuna az rastlanmaktadır. Biz burada başlangıç kliniği sol taraflı istemsiz hareketler olan, yapılan tetkiklerde hiperglisemi saptanan, iyi regüle edilememiş tip 2 diabetes mellitus (DM) özgeçmişi olan ve kranyal manyetik rezonans görüntülemede (MRG) bazal ganglionlar düzeyinde venöz anjiom tespit edilen bir olguyu sunuyoruz. Kırk dokuz yaşındaki kadın hasta, yaklaşık bir aydır sol kol ve sol bacakta, istemsiz, atma şeklindeki hareket şikayeti ile başvurdu. Özgeçmişinde hipertansiyon ve tip 2 DM öyküsü vardı. Hastanın muayenesinde sol taraflı, kalça ve omuzdan başlayan, şiddetli, atma şeklinde hemiballizm görüldü. Hastanın bakılan tetkiklerinde kan şekeri 400 mg/dL olarak ölçüldü. Kranyal MRG'sinde sağ nükleus lentiformis düzeyinde venöz anjiyom ve sağ lateral ventrikül korpus lateralinde, subependimal yerleşimli, vasküler malformasyonu düşündüren lezyon tespit edildi ve ardından dijital dört damar serebral anjiyografisinde gösterildi. Takibinde kan şekeri regülasyonu sağlanan hastanın hemiballizminde tama yakın klinik düzelme oldu. Özellikle ileri yaşlı olgularda, akut veya subakut başlangıçlı kore-ballizm, özellikle sekonder nedenleri akla getirmelidir. Vasküler malformasyona bağlı hemiballizm, hemikore ve hiperglisemi birlikteliği olgusuna az rastlanmaktadır. Sunulan olguda iyi regüle edilememiş DM hastamızın kliniğinin belirmesinde kolaylaştırıcı etken olduğunu ve yine literatürde az rastlanan venöz anjiyom ve kore-ballizm birlikteliğinde, venöz anomalinin özellikle kitle etkisinin klinikten sorumlu olabileceğini düşünüyoruz.

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

Cited by 36 publications

References 7 publications

Hyperglycemia-Induced Involuntary Movements: 2 Case Reports and a Review of the Literature

Hyperglycemia-Induced Involuntary Movements: 2 Case Reports and a Review of the Literature

Clinics in diagnostic imaging (166)

Hemichorea and Hemiballismus Associated with Cerebral Vascular Malformation Induced by Hyperglycemia: Case Report

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