Chorea in a Non-Ketotic Hyperglycemic State: Case Report

Abstract

Context: Non-ketotic hyperglycemia is a rare cause of chorea. Clinical findings are usually unilateral and potentially reversible after treatment for hyperglycemia. Hyperglycemia leads to asymmetric multifocal petechial hemorrhages of the basal ganglia, leading to a dysfunction of neuronal networks that connect the basal ganglia and the motor cortical areas, mainly affecting the subthalamic nucleus and contralateral striatum, which is highlighted by typical hyperdense lesions of the basal ganglia in computed tomography (CT) of the brain. This study aimed to report a case of a patient with choreiform movements due to a rare etiology of hyperglycemia nonketotic in a Hospital Public of Joinville, SC. The study was carried out through the collection and analysis of a patient’s medical record. Case report: Female patient, 54 years old, who presented for 6 days choreiform movements in the face, left upper limb and, discreetly, in the left lower limb. Snake tongue sign and milkmaid’s grip positive, without dysarthria. In the laboratory exam, glucose of 600 mg / dL; without further changes. Cranial tomography showed hyperdensity in the putamen region on the right. The treatment was started to obtain better glycemic control and Risperidone 3 mg / day. Conclusions: It is concluded, then, that non-ketotic hyperglycemia is an uncommon, but reversible cause of chorea, and may manifest itself due to an uncontrolled non-ketotic diabetes mellitus. Its pathogenic mechanism remains to be clarified. In addition, clinical, epidemiological, imaging and laboratory findings, together, corroborate for early diagnosis and proper management.