A case of hemichorea‐hemiballism presenting in association with diabetic ketoacidosis

Abstract

AbstractMovement disorders are a rare but recognised manifestation of non‐ketotic hyperglycaemic episodes on a background of poorly‐controlled diabetes mellitus. The literature is otherwise sparse when it comes to an association between hemichorea‐hemiballism and diabetic ketoacidosis (DKA).A patient with no past medical history of note was admitted with a sudden‐onset involuntary movement disorder and was found to be in DKA during her inpatient stay. There was a delay in diagnosis and management as all efforts pointed in the direction of diagnosing the cause of the sudden‐onset hemichorea‐hemiballism as a potential cerebrovascular event. The movements subsided with treatment of the ketoacidosis and with the addition of tetrabenazine. Imaging revealed a hyperdensity of the left basal ganglia consistent with a metabolic cause and not an ischaemic event.Although the pathophysiology of movement disorders in diabetes is still unclear, this case highlights the importance in maintaining a wide list of differentials when faced with an atypical presentation of hemichorea‐hemiballism, especially as DKA is a reversible emergency with high mortality rates if left untreated. Hemichorea‐hemiballism as a consequence of DKA seems to be a multifactorial phenomenon. In this case, it began with non‐ketotic hyperglycaemia and evolved into ketoacidosis. Confounding factors precipitating this included infection, and delayed diagnosis and management. Copyright © 2017 John Wiley & Sons.