Chorea as a rare neurological complication of hyperglycaemia

Abstract

Chorea is a hyperkinetic movement disorder characterised by brief involuntary, random, and irregular contractions. It’s caused by multiple conditions, including neurodegenerative diseases, cerebrovascular disease, structural damage to deep brain structures, neoplastic diseases, or metabolic derangements, such as hyperglycaemic states. We present a case of an 81-year-old woman, with a history of long-term poorly controlled type 2 diabetes mellitus, admitted to the emergency department with hyperkinetic delirium in the last 48h. At examination, she presented with mild right central facial paresis, and involuntary bilateral movement of the four limbs, more prominent on the right side. Laboratory tests showed hyperglycaemia of 799 mg/dl with ketonemia of 5.2 mg/dL and glycated hemoglobin of 11%. Computed tomography (CT) scan of the brain showed bilateral hyperdensity of the corpus striatum. The treatments included glycemic control with insulin, intravenous fluids, and anti-epileptic drugs. A clinical improvement was observed however, the patient continued to show chorea-like movements of the four limbs. The magnetic resonance imaging (MRI) showed a T2-flair and T2-weighted area of hypo-intensity involving bilaterally the striatum corpus and the corresponding signal in T1. She was then diagnosed with hyperglycaemia-associated chorea and improved significantly after initiation and titration of clonazepam and tetrabenazine. This case report pretends to highlight the importance of considering a rare manifestation of a very common disease. A hyperglycaemic state that can lead to cerebral lesions and specific neurological manifestations.