Chorea hyperglycemia basal ganglia (C-H-BG) syndrome as the first presentation of type 2 diabetes mellitus in a 65-year-old male

Abstract

Background Chorea Hyperglycemia Basal Ganglia (C-H-BG) Syndrome is a known complication of nonketotic hyperglycemia among patients with long term uncontrolled diabetes mellitus. The condition is mainly reported in the elderly Asian population with a female preponderance. C-H-BG syndrome in previously undiagnosed diabetic patients also rarely been reported. We report a case of C-H-BG syndrome as the first presentation of Diabetes mellitus in a male patient. To our knowledge this is the first such case reported in Sri Lanka. Case A 65-year-old previously healthy male who presented with acute onset left sided choriform movements for 6 days, had high blood sugar values on admission. He had no previous manifestations of hyperglycemia and no other micro or macro vascular complications of diabetes were noted. His non-contrast CT of the brain (fig.1) revealed characteristic asymmetrical high intensity signals in bilateral basal ganglia. MRI brain revealed non-contrast enhancing T1 high intensity signals in bilateral basal ganglia mainly involving right lentiform nucleus (fig.2) and low intensity in T2 with normal FLAIR images. He found asymptomatic after 2 weeks, with good glycemic control. Conclusion C-H-BG Syndrome should be considered in patients with acute onset hemichorea, irrespective of their previous history of Diabetes mellitus. Good glycemic control alone can cure C-H-BG syndrome in majority of patients.