Hemichorea-Hemiballism Secondary to Non-Ketotic Hyperglycemia

Abstract

Non-ketotic hyperglycemia is an unusual and rare cause of hemichorea-hemiballismus. Correction of the hyperglycemia usually results in total resolution of the signs and symptoms. We present the case and medical imaging findings of a 66-year-old female who presented with steadily worsening choreiform and ballistic movements of the right upper and lower extremities over a 2-week period. Her serum glucose was greater than 600 mg/dL, and no ketones were present. CT scan and MR demonstrated left basal ganglia abnormalities suggesting hyperglycemia-related hemichorea-hemiballismus syndrome. Restoration of euglycemia led to eventual resolution of all symptoms. Knowledge of this disorder is paramount so as to rule out other causes of intracranial pathology.

Keywords: Chorea; Dyskinesias; Hyperglycemia.

Figure 1

Axial CT demonstrated increased density within the caudate nuclei and left lentiform nucleus (arrow).

Figure 2

There was minimal increased signed intensity on the diffusion-weighted imaging sequence (arrow) (a), as well as T1 shine through on the time of flight sequence (arrow) (b).