Striatal Hyperintensity in Non-Ketotic Hyperglycemia Induced Hemichorea-Hemiballismus Syndrome: Case Report

Abstract

Introduction: Hemichorea-Hemiballismus (HC-HB) is usually associated with lesions in the contralateral basal ganglia of the central nervous system and can be caused by infection, neurodegeneration, oncological cases, stroke, and metabolic disorders. HC-HB disorders associated with non-ketotic hyperglycemia are rare and are characterized by involuntary and arrhythmic unilateral movements. This occurrence is more common in cases of women, the elderly and poor control of blood sugar levels. Case Report: A female patient 46 years old, came with complaints of uncontrolled movements in the right half of the body since July 2021. Then it spread to the legs also 1 month later. Prior to this complaint, it was triggered by a stressor. History of non-routine use of drugs. On general physical examination and vital signs within normal limits. Neurological examination found right hemichorea with arrhythmic characteristics, 1-5 Hz, medium-large amplitude, stereotypy, right arm and leg, suppressibility (+), worsens when stressed. A CT-Scan of the head without contrast showed no abnormalities, but an MRI revealed a non-ketotic hyperglycemic image. The patient then received haloperidol 0.75 mg orally every 12 hours and clobazam 5 mg every 12 hours orally and insulin therapy. Discussion: In this case report, it was found that female patients was poor in control her blood glucose and causing complications. This condition also known as diabetic striatopathy (DS). Several mechanisms to explain the pathogenesis of DS include metabolic disorders, ischemic injury resulting in ion deposition, hemorrhagic injury, dopaminergic and estrogenic imbalances, autoimmune inflammatory responses, and neurodegeneration. This is supported by MRI imaging that supports the presence of hyperintense on T1. Keywords: Hyperglycemia, Involuntary Movement, Striatopathy