Non-ketotic Hyperglycemic Hemichorea-Hemiballismus: A Case of a Male With Diabetes Mellitus and Speech Disturbances

Abstract

Non-ketotic hyperglycemic chorea-ballismus is characterized by a triad of chorea-ballismus, non-ketotic hyperglycemic state, and striatopathy on magnetic resonance imaging (MRI) or computerized tomography scan (CT). Chorea and ballismus are hyperkinetic movements affecting the side contralateral to the striatal hyperintensity on imaging. This presentation is a manifestation of poorly controlled diabetes mellitus most commonly reported in elderly eastern Asian women. The exact mechanism is unknown, but it is reversible with optimal glycemic control. The patient described in this case is a Caucasian male in his mid-50s who presented to the emergency department with speech disturbance. Only after a detailed neurologic examination and MRI head in the setting of non-ketotic hyperglycemia the diagnosis of non-ketotic hyperglycemia hemichorea-hemiballismus was deduced. Consideration of this disease in patients with poorly controlled diabetes mellitus is important as tight glycemic control can be implicated to reverse the condition.