Diabetic Hemichorea-hemiballism after Prompt Improvement in Hyperglycemia

Abstract

We herein report a case of hemichorea-hemiballism in an 85-year-old man diagnosed with diabetes at 76 years of age. After a one-year interruption in treatment, he was treated with a low-calorie diet, linagliptin, and nateglinide. Over 51 days, his HbA1c level decreased from 15.8% to 7.7%. After a prompt improvement in his hyperglycemia, he began experiencing involuntary movements in the right upper and lower extremities. T1-weighted magnetic resonance imaging showed a high signal intensity in the left lens nucleus. The patient was diagnosed with diabetic hemichorea-hemiballism and received haloperidol (1 mg/day) as treatment.

Keywords: diabetic hemichorea-hemiballism; lens nucleus; prompt improvement of hyperglycemia.

Figure 1.

Change in HbA1c levels. Over 51 days, from the beginning of June 2015 to the end of July 2015, the patient’s HbA1c level decreased by 8.1%, from 15.8% to 7.7%. At the end of June 2015, involuntary movements in his right lower extremity were observed. A few days later, the involuntary movements progressed to the right upper extremity.

Figure 2.

Brain magnetic resonance imaging findings. Brain magnetic resonance imaging was performed three times: at the end of July, at the beginning of August, and at the end of November, 2015. On the T1-weighted images, the high signal intensity observed in the lens nucleus peaked at the beginning of August and improved in November.