Non-ketotic Hyperglycemia Hemichorea-Hemiballismus: A lucky Catch

Abstract

Cristina Corsini

Case Summary: A 73-year-old man with past medical history of hypertension, type 2 diabetes mellitus and depression, presented with new onset right arm and leg movements. The physical exam showed right hemi body choreic movements and decreased reflexes to 1+ on the affected side. Laboratory abnormalities included blood glucose level of 310 mg/dL and a glycohemoglobin of 13.6 mg/dL. CT head showed increased density of the right caudate nucleus and right lentiform nucleus. Blood glucose was controlled by adjusting his insulin regimen and his abnormal movements resolved within seven days.

Discussion: Development of involuntary movements is one of the least common neurological manifestations in uncontrolled diabetes mellitus and, it is more common in elderly patients. Contralateral hyperdensities in the contralateral basal ganglia in the CT is essential for diagnosis. Course and prognosis are benign. Most cases achieve a full recovery within six months of strict glucose control.

Conclusion: Strict glucose control is the primary therapy for neurological complications in non-controlled diabetes mellitus. Proper identification of the disease is fundamental for the prompt resolution of symptoms.

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