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
Case Reports
. 2018 Jun 19:2018:bcr2018224856.
doi: 10.1136/bcr-2018-224856.

Bilateral chorea/ballismus: detection and management of a rare complication of non-ketotic hyperglycaemia

Venkata Sunil Bendi  1 , Abhishek Matta  2 , Diego Torres-Russotto  1 , James Shou  1
Affiliations
Case Reports

Bilateral chorea/ballismus: detection and management of a rare complication of non-ketotic hyperglycaemia

Venkata Sunil Bendi et al. BMJ Case Rep. .

Abstract

Non-ketotic hyperglycaemia (NKH) is the most common metabolic cause of hemichorea-hemiballismus (HC-HB) and an often-reversible condition. A 68-year-old man presented to the emergency department with a severe hyperglycaemic episode and altered mental status. He was treated appropriately and discharged home after his blood glucose levels were normal with an improvement of mental status. Four weeks after the discharge, he returned with flailing movements of bilateral upper and lower limbs. MRI of the brain revealed hyperintensities of the bilateral putamen on T1-weighted imaging. The patient's symptoms improved with a combination of amantadine, clonazepam and tetrabenazine. Several hypotheses involving gemistocytes, calcification and petechial haemorrhage were proposed in support of imaging abnormalities in the striatum. Dopamine-depleting agents and neuroleptics are used in the treatment of chorea. It is recommended to try a dose of tetrabenazine in patients with NKH-induced HC-HB if no improvement is appreciated with initial treatment of glycaemic control.

Keywords: diabetes; movement disorders (other than parkinsons); neuroimaging; neurology (drugs and medicines).

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Hyperintense lesions of the bilateral putamen on T1-weighted MRI. PF, Posterior Fossa.
See this image and copyright information in PMC

References

    1. Dewey RB, Jankovic J. Hemiballism-hemichorea. Clinical and pharmacologic findings in 21 patients. Arch Neurol 1989;46:862–7. - PubMed
    1. Oh SH, Lee KY, Im JH, et al. . 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. - PubMed
    1. Lai PH, Tien RD, Chang MH, et al. . Chorea-ballismus with nonketotic hyperglycemia in primary diabetes mellitus. AJNR Am J Neuroradiol 1996;17:1057–64. - PMC - PubMed
    1. Cosentino C, Torres L, Nuñez Y, et al. . Hemichorea/hemiballism associated with hyperglycemia: report of 20 cases. Tremor Other Hyperkinet Mov 2016;6:402 10.7916/D8DN454P - DOI - PMC - PubMed
    1. Bedwell SF. Some observations on hemiballismus. Neurology 1960;10:619–22. 10.1212/WNL.10.6.619 - DOI - PubMed

Publication types

Substances

LinkOut - more resources