Comparison of Hemichorea-Hemiballism between Acute Stroke and Nonketotic-Hyperglycinemia in the Clinical Scenario: Report of a Rare Diabetic Complication

Po-Jen Hsiao,Hann-Yen Shyu,Ching-I Lin,Jenq-Shyong Chan,Tai-You Guo,Chia‐Chi Kuo ,Minghua Chen

doi:10.3823/2600

Abstract

Diabetes mellitus is the major cause of retinopathy, nephropathy and neuropathy. Hyperglycemia is one of major major advised effect on diabetes mellitus. Hemichorea-hemiballism, a rare manifestation of nonketotic hyperglycemia, characterized by involuntary arrhythmic motions in one side of the body which results from focal lesions in the contralateral basal ganglia. Here, we present a 39-year-old woman with violent involuntary rapid and irregular movements of left limbs three days prior to emergency department. Nonketotic hyperglycemia related hemichorea-hemiballism had been confirmed by biochemistry examination and brain computed tomography (CT). Aggressive glucose control with insulin was administered. Her symptoms got improvement gradually after euglycemia two weeks later.

Highlights

Hemiballism is an unusual excessive movement disorder characterized by high amplitude arrhythmic motions, especially in the shoulder and a2005a660820@yahoo.com.tw
Current theories advocate that the deficiencies in functional connectivity rather than a single basal ganglia lesion account for these disorder
The interruption of the connections between internal globus pallidus, subthalamic nucleus, and thalamus may further cause a disturbance in the basal ganglia-cortical circuit

Summary

Introduction

Acute development of hemichorea-hemiballism is often caused by focal lesions in the contralateral subthalamic nucleus [13]. Severe stenosis of right internal carotid artery and atherosclerosis of basilar artery may worsen the insufficient cerebral vessel supply to subthalamic nucleus [1,2,3,4,5]. The prognosis of hemichorea-hemiballism varies significantly by the etiology; the majority of patients usually have response to medical treatment. A 74-year-old man presented with sudden onset continuous, involuntary flailing, violent, and undesired movements of left entire limbs after nap, since six hours prior to emergency department. There was improvement in his involuntary movements of left limbs after 3-month follow-up

Findings

Discussion

Conclusion