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            : Hemichorea-hemiballismus secondary to nonketotic hyperglycemia

Vale, Thiago Cardoso; Freitas, Denise da Silva; Maciel, Ricardo; Miranda, Eduardo Carvalho; Cardoso, Francisco

doi:10.1212/wnl.0b013e31828cf85d

Cited by 8 publications

(3 citation statements)

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“…Most patients with chorea associated with NKH present acute or subacute onset of limb involuntary activities (more common in unilateral), sometimes involuntary movements also appear in the facial muscle, jaw, and tongue, accompanied by severe increase in blood glucose and negative ketones in urine. There are characteristic radiographic manifestations under normal circumstances: the contralateral striatum in MRI T1-weighted show high signal changes and equal or low signal in MRI T2-weighted, mostly high-density changes in head CT. [ 8 , 9 ] With the improvement of the condition, the image changes can weaken or disappear. In addition, as reported above, there are very few patients with a negative performance in MRI or CT scan.…”

Section: Discussionmentioning

confidence: 99%

Chorea associated with nonketotic hyperglycemia

Chang¹,

Hong²,

Yu³

et al. 2017

Medicine

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Introduction:This is a unique case of nonketotic hyperglycemic (NKH) chorea in 84-year-old Asian woman. The patient had a history of type 2 diabetes mellitus more than 30 years, but had a poor control of blood sugar. She complained of acute onset of bilateral limb involuntary activities, and being easy to fall within a week. Laboratory testing disclosed hyperglycemia (669 mg/dL), glycated hemoglobin (14%), and normal ketones. The brain computed tomography scan and magnetic resonance imaging did not disclose any abnormality in the basal ganglion unlike most cases. The patient was then diagnosed with NKH chorea. Her symptoms improved quickly.Conclusions:NKH chorea with normal imaging may represent a new subtype.

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Section: Discussionmentioning

confidence: 99%

Chorea associated with nonketotic hyperglycemia

Chang¹,

Hong²,

Yu³

et al. 2017

Medicine

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“…Seizures, cerebral edema, and central pontine myelinolysis (CPM) are uncommon but well-described and serious complications of diabetes. 33,34 Indeed, one of the most important effects of the increased serum osmolarity is on the brain. Increased plasma osmolarity can promote extracellular fluid (ECF) shift.…”

Section: Complicationsmentioning

confidence: 99%

Metabolic and Endocrine Challenges

Bonicolini

Parekh

Thein

et al. 2020

Semin Respir Crit Care Med

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This review aims to provide an overview of metabolic and endocrine challenges in the setting of intensive care medicine. These are a group of heterogeneous clinical conditions with a high degree of overlap, as well as nonspecific signs and symptoms. Several diseases involve multiple organ systems, potentially causing catastrophic dysfunction and death. In the majority of cases, endocrine challenges accompany other organ failures or manifest as a complication of prolonged intensive care unit stay and malnutrition. However, when endocrine disorders present as an isolated syndrome, they are a rare and extreme manifestation. As they are uncommon, these can typically challenge both with diagnosis and management. Acute exacerbations may be elicited by triggers such as infections, trauma, surgery, and hemorrhage. In this complex scenario, early diagnosis and prompt treatment require knowledge of the specific endocrine syndrome. Here, we review diabetic coma, hyponatremia, hypercalcemia, thyroid emergencies, pituitary insufficiency, adrenal crisis, and vitamin D deficiency, highlighting diagnostic tools and tricks, and management pathways through defining common clinical presentations.

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“…54 Seizures, including epilepsia partialis continua, and focal neurologic signs such as hemichorea and hemiballismus have also been reported in patients with a hyperglycemic hyperosmolar state (Figure 8-3). 57,58 Even if an infection was the inciting cause for the hyperglycemic crisis, patients can be normothermic or even hypothermic due to peripheral vasodilation. 54 Diagnosis and management.…”

Section: Epidemiology and Pathophysiologymentioning

confidence: 99%