Abstract
Hemichorea-hemiballism is an unusual hyperkinetic movement disorder characterized by continuous involuntary movements of an entire limb or both limbs on one side of the body. The acute onset of this disorder occurs with an insult in contralateral basal ganglia. Ischemic events represent the most common cause. Nonketotic hyperglycemia comes in second place. Nonketotic hyperglycemic hemichorea-hemiballism (NHH) is a rare cause of unilateral brain abnormalities on imaging studies confined to basal ganglia (mainly putaminal region as well as caudate nucleus). Subtle hyperdensity in striatal region can be found on CT studies whereas brain MR imaging typically shows T1 hyperintensity and T2 hypointensity in the basal ganglia contralateral to the movements. Diagnosis is based on both glucose levels and neuroimaging findings. Elevated blood glucose and hemoglobin A1c levels occur with poorly controlled diabetes. In this case report, our aim is to present neuroimaging CT and MR unilateral findings in an elderly woman secondary to nonketotic hyperglycemia presenting as hemichorea-hemiballism.
Highlights
Hemichorea-hemiballism is an unusual hyperkinetic movement disorder characterized by continuous involuntary movements of an entire limb or both limbs on one side of the body
Bedwell first described hemichorea-hemiballism associated with hyperglycemia in 1960
He reported the case of a 57year-old woman with hemiballism that resolved as the blood glucose levels were normalized [2]
Summary
Hemichorea-hemiballism is an unusual hyperkinetic movement disorder characterized by continuous involuntary movements of an entire limb or both limbs on one side of the body. Bedwell first described hemichorea-hemiballism associated with hyperglycemia in 1960 He reported the case of a 57year-old woman with hemiballism that resolved as the blood glucose levels were normalized [2]. It was Yahikozawa et al who first reported 3 diabetic patients with the unique combination of hemiballism and striatal hyperintensity on T1-weighted MRI as a new syndrome in 1994 [3]. This syndrome usually occurs in patients with previously known diabetes, it could be an initial manifestation of diabetes [5]
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