Hemichorea-hemiballismus in non-ketotic hyperglycaemia

Abstract

Hemichorea-hemiballismus is a rare complication of nonketotic hyperglycaemia in type 2 diabetes. It is associated with contralateral striatal radiological abnormality, most typically T1 hyperintensity on MRI. We report a case of a 91 year old woman who presented in a nonketotic hyperglycaemic state with right sided hemichorea. Brain CT revealed hyperdensity of the left lentiform nucleus and MRI 15 days post presentation showed left lentiform T1 hyperintensity and enlargement. The chorea improved after control of blood glucose levels. The pathophysiology of this syndrome remains controversial. It is likely that a combination of hyerglycaemia induced basal ganglia metabolic derangement and failure of cerebral blood flow autoregulation contribute to the syndrome.