Hemichorea-Hemiballismus Revealing Diabetes Mellitus

Abstract

Nonketotic hyperglycemia is a rare cause of hemichorea-hemiballismus. We report a case hemichorea-hemiballismus secondary to nonketotic hyperglycemia revealing an inaugural diabetes mellitus. A 55 year-old woman, admitted for subacute-onset of continuous involuntary movements in the right upper and lower limb since three days ago. The movements increased with action, decreased with relaxation, and disappeared during sleep. As the condition did not affect her trunk, other limbs, or her face and no other conditions were evident. At admission, the right upper and lower limb was moving involuntarily. The movement was wild, flailing, and repetitive with varied amplitudes and frequencies. No tremor and rigidity were elucidated and cerebellar signs were negative. Laboratory tests revealed diabetes mellitus, with a fasting blood glucose level of 4,60 g/L and a hemoglobin A1C level of 14.0%. The urine examination was negative for ketones. CT of the brain showed left pallidum hyperdensity. The brain MRI revealed hyperintense signal in the left pallidum on T1-weighted images and isointensity on T2-weighted images. Other laboratory results were within the normal range. A diagnosis of hyperglycemia-associated hemichorea-hemiballismus was made. An insulin treatment and oral antidiabetics were instored. She was subsequently discharged after 14 days of hospital stay with improved glycemic control. Three months after, her chorea-ballismus was completely resolved. A control of brain MRI six month after showed marked improvement in the putaminal changes. Vigilance for this cause of hemichorea-hemiballism is important, since the movement disorder may be the presentation of potentially dangerous underlying hyperglycemia.