Complete Disappearance of Hemichorea-Hemiballism due to Hyperglycemia following Acute Ischemic Stroke

Abstract

A 70-year-old right-handed woman with a history of noninsulin-dependent diabetes suddenly developed involuntary movements of the right arm and leg. At that time, blood glucose levels were 500 mg/dl. The patient manifested continuous, involuntary movements on the right side of the body. Neurological examination showed severe HC-HB with superimposed dystonic posturing on the right side. The movements could not be suppressed voluntarily but ceased during sleep. Muscle tone and the strength of the upper and lower limbs were normal on both sides. There was no evidence of sensory impairment, and cranial nerves were normal. A laboratory examination showed that the glycosylated hemoglobin A1c level was 7.9%. Urine was negative for ketones, indicating nonketotic hyperglycemia. Serum levels of vasculitis factors, blood cell acanthocytosis, and the electroencephalography were all normal. A brain magnetic resonance imaging (MRI) scan showed an irregular area of high-signal intensity involving the left caudate nucleus and putamen in a T1-weighted image ( fig. 1 ). The patient was diagnosed with nonketotic hyperglycemia-induced HC-HB, and risperiDear Sir, Hemichorea-hemiballism (HC-HB) is a hyperkinetic disorder that is characterized by continuous, nonpatterned, proximal, and involuntary movements on one side of the body resulting from involvement of the contralateral basal ganglia, particularly the striatum. HC-HB may be associated with a wide variety of diseases, such as cerebrovascular, inflammatory, and infectious diseases, drugs, metabolic derangement, neurodegenerative disorders, and tumors [1, 2] . Nonketotic hyperglycemia has occasionally been associated with various neurological abnormalities, including movement disorders [3] . Recently, a few reports have described patients with nonketotic hyperglycemia who presented with HC-HB [4–6] . The HC-HB caused by nonketotic hyperglycemia often abruptly recovered after hyperglycemia had been successfully controlled, but in rare cases, it could be sustained for a few years [7] . To the best of our knowledge, the disappearance of sustained hyperglycemia-induced HC-HB following cerebrovascular disease has not yet been documented. Therefore, we herein describe a patient who had complete resolution of hyperglycemia-induced HCHB following a discrete contralateral striatal infarction. Received: May 27, 2011 Accepted: September 16, 2011 Published online: November 15, 2011