Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Aug 5:6:393.
doi: 10.7916/D8QZ2B3F. eCollection 2016.

Irreversible Hemichorea-Hemiballism in a Case of Nonketotic Hyperglycemia Presenting as the Initial Manifestation of Diabetes Mellitus

Ujjawal Roy  1 , Shyamal Kumar Das  1 , Adreesh Mukherjee  1 , Debsadhan Biswas  1 , Koushik Pan  1 , Atanu Biswas  1 , Ajay Panwar  2
Affiliations

Irreversible Hemichorea-Hemiballism in a Case of Nonketotic Hyperglycemia Presenting as the Initial Manifestation of Diabetes Mellitus

Ujjawal Roy et al. Tremor Other Hyperkinet Mov (N Y). .

Abstract

Background: Hemichorea-hemiballism (HCHB) is a hyperkinetic movement disorder with features of both chorea and ballism occurring on the same side.

Case report: We present a case of HCHB due to nonketotic hyperglycemia (NKH) that was the initial presentation of diabetes and was irreversible clinically even after 6 months of optimal blood sugar control.

Discussion: Although HCHB due to hyperglycemia is a potentially reversible condition in the majority of patients, prolonged uncontrolled hyperglycemia may cause ischemic insult and persistent symptoms. Hyperglycemia should always be kept in the list of differentials while dealing with patients who are newly diagnosed with HCHB.

Keywords: Hemichorea–hemiballism; magnetic resonance spectroscopy; nonketotic hyperglycemia.

PubMed Disclaimer

Conflict of interest statement

Funding: None. Conflict of Interest: The authors report no conflict of interest. Ethics Statement: All patients that appear on video have provided written informed consent; authorization for the videotaping and for publication of the videotape was provided.

Figures

Figure 1
Figure 1. Brain Computed Tomography. The scan revealed hyperdensity of the lentiform and caudate nuclei that was more prominent on the right side.
Figure 2
Figure 2. Brain Magnetic Resonance Imaging. Axial T1 (A) and coronal (C) sequences showing hyperintensity of the right putamen (single arrow) and caudate nucleus (double arrow) that enhanced mildly on contrast (B) with a normal gradient echo sequence (D).
See this image and copyright information in PMC

References

    1. Oh SH, Lee KY, Im JH, Lee MS. Chorea associated with non-ketotic hyperglycemia and hyperintensity basal ganglia lesion on T1-weighted brain MRI study: a meta-analysis of 53 cases including four present cases. J Neurol Sci. 2002;200:57–62. doi: 10.1016/S0022-510X(02)00133-8. - DOI - PubMed
    1. Ohara S. Diabetic hemichorea-hemiballism. Austin J Clin Neurol. 2015;2((4)):1037.
    1. Lai PH, Tien RD, Chang MH, et al. Chorea-ballismus with nonketotic hyperglycemia in primary diabetes mellitus. AJNR Am J Neuroradiol. 1996;17:1057–1064. - PMC - PubMed
    1. Tung CS, Guo YC, Lai CL, Liou LM. Irreversible striatal neuroimaging abnormalities secondary to prolonged, uncontrolled diabetes mellitus in the setting of progressive focal neurological symptoms. Neurol Sci. 2010;31((1)):57–60. doi: 10.1007/s10072-009-0127-6. - DOI - PubMed
    1. Piccolo I, Defanti CA, Soliveri P, Volontè MA, Cislaghi G, Girotti F. Cause and course in a series of patients with sporadic chorea. J Neurol. 2003;250((4)):429–435. doi: 10.1007/s00415-003-1010-7. - DOI - PubMed

LinkOut - more resources