Hypoglycemia-induced hemichorea in a patient with Fahr’s syndrome

Abstract

Non-ketotic hyperglycemia may be a cause of hemiballism-hemichorea. We present an elderly female type II diabetic patient with right-sided hemiballism-hemichorea of acute onset during hypoglycemia following insulin overtreatment of non-ketotic hyperglycemia. Brain computerized tomography and magnetic resonance imaging scans revealed characteristic hyperdensity and T1 hyperintensity, respectively, in the left basal ganglia, in addition to pallido-dentate calcifications, suggestive of Fahr's syndrome. Although extremely rare, hypoglycemia may be a cause of hemiballism-hemichorea especially in the presence of predisposing factors such as previous hyperglycemic episodes and Fahr's syndrome.

Hemichorea and dystonia due to frontal lobe meningioma

“…Although hemichorea is a very rare form of a movement disorder, it is mostly associated with vascular malformation, tumors or tuberculoma in the basal ganglia, hemorrhagic or ischemic stroke, metastasis, non-ketotic hyperglycemia, and hypoglycemia. [3,5] Our patient only had a heavily calcified large meningioma, as evident from the MRI, which could have compressed or impaired the extrapyramidal system leading to various movement disorders as noted in the prior research. [7] After consultation and weighing the risks as well as benefits of the surgical removal of the large meningioma in our patient, the neurosurgeon advised against the surgical removal of the tumor.…”

“…It should be noted that although hemichoreas mostly result from a vascular malformation, tumors or tuberculoma in the basal ganglia, hemorrhagic or ischemic stroke, metastasis, non-ketotic hyperglycemia, and hypoglycemia, our patient did not have anything except for a frontal lobe meningioma. [3,5]…”

Hemichorea and dystonia due to frontal lobe meningioma

“…[35] Our patient only had a heavily calcified large meningioma, as evident from the MRI, which could have compressed or impaired the extrapyramidal system leading to various movement disorders as noted in the prior research. [7]…”

Different Magnetic Resonance Imaging Manifestations of Diabetic Chorea in a Case with Hyperglycemia and Another One with Hypoglycemia

“…Because SU and DPP-4I combinations are known to cause hypoglycemia [7], and the patient presented no hyperglycemia on admission, we considered that the use of SU and DPP-4I may have led to hypoglycemia and subsequent DC. There is also been a report of an elderly woman with type 2 diabetes and hypoglycemia associated with insulin treatment that led to DC [6]. It is possible that the hypoglycemia also associated with diabetes therapy in elderly patients may cause DC.…”

“…However, there are DCs without the typical images on MRI [5] or that occur in cases of hypoglycemia, not hyperglycemia [6]. Here we describe two DC patients with different MRI findings.…”