Hemichorea-Hemiballism as the First Presentation of Type 2 Diabetes

Abstract

Hemichorea-hemiballism (HCHB) is a hyperkinetic disorder characterized by continuous, nonpatterned, proximal, involuntary movements on one side of the body, resulting from involvement of the contralateral basal ganglia and particularly the striatum. We report here an interesting case of sudden onset HCHB associated with nonketotic hyperglycemia, with complete remission of symptoms after control of blood glucose. HCHB as the first presentation of type 2 diabetes has been described rarely. This case report reinforces that, especially in elderly patients with newly diagnosed HCHB, nonketotic hyperglycemia should be recognized promptly. Early diagnosis and treatment of hyperglycemia yield an excellent prognosis. A 61-year-old man presented after 2 days’ duration of sudden-onset involuntary movements of the left side, first involving the upper limb and 6 hours later involving the homolateral lower limb. There was no history of stroke or preceding trauma. He was conscious and alert, with normal higher mental functions and cranial nerve examination. He had periodic choreiform and ballistic movements of the left upper and lower extremities that could not be suppressed voluntarily but that ceased during sleep. Initial biochemistry revealed a random blood glucose of 527 mg/dL, a normal venous pH (7.37), and negative blood ketones (0.5 mmol/L). A diagnosis was made of diabetic nonketotic hyperosmolar state causing HCHB. The patient’s A1C was …