A Rare Clinical Presentation of Diabetes Mellitus

Abstract

This case report highlights a rare presentation of new-onset diabetes. Hemichorea- hemiballismus due to nonketotic hyperglycemia is a rare disorder, which comprises of unilateral, periodic choreiform movement of the extremities in the setting of hyperglycemia without evidence of ketoacidosis. Radiographically, there is hyperdensity in the basal ganglia but no evidence of bleeding or mass effect on CT scan of the brain. MRI of the brain shows increased T1-signal intensity in the contralateral putamen. The immunopathology is hyperglycemia mediated, which causes ischemic excitation of GABAergic-neurons in the basal ganglia. This leads to excessive inhibition of subthalamic nuclei and excitatory cortical input causing involuntary movement unilaterally. The mainstay treatment of this condition is insulin therapy, and the movement disorder disappears once glycemic control is achieved.