Hemichorea-Hemiballismus as an Unusual Presentation of Hyperosmolar Hyperglycemic Syndrome

Javier Ticona¹, Victoria Zaccone¹, Unaiza Zaman¹, Daniel Kashani¹, Zachary Chung¹ and Isabel M. McFarlane^1,

¹Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203 USA

Cite this paper

Javier Ticona, Victoria Zaccone, Unaiza Zaman, Daniel Kashani, Zachary Chung and Isabel M. McFarlane. Hemichorea-Hemiballismus as an Unusual Presentation of Hyperosmolar Hyperglycemic Syndrome. American Journal of Medical Case Reports. 2020; 8(6):159-161. doi: 10.12691/AJMCR-8-6-6

Abstract

Diabetes mellitus can lead to a diverse array of systemic complications. Poorly managed hyperglycemia can result in serious neurological consequences ranging from peripheral neuropathy to seizures and coma. A rare neurologic disorder seen in acute decompensated type 2 diabetes mellitus (T2DM) is hemichorea-hemiballismus (HCHB). HCHB is a movement disorder primarily associated with cerebrovascular accidents of infarct or hemorrhagic origin. It is a condition that can occur in a diabetic patient, especially when no other signs or symptoms of hyperglycemia are present. It is urgent to recognize HCHB movement disorder quickly as it may be the only presenting sign of hyperglycemia and can alert medical personnel to a possible hyperosmolar hyperglycemic state (HHS). We report an unusual case of HCHB in a patient with HHS, whose only presenting sign was unilateral hyperkinesis, which completely resolved after adequate blood glucose control. Prompt treatment and management of hyperglycemia yields an excellent prognosis in HCHB.

Keywords

type 2 diabetes mellitus, movement disorders, chorea, hemiballismus, hyperosmolar hyperglycemic syndrome, basal ganglia

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Cardoso FJ, Seppi KK, Mair Kundefined, Wenning Gundefined, Poewe Wundefined. Seminar on choreas. The Lancet. Neurology. 2006.
[2]	Hsu JL, Wang H-C, Hsu W-C. Hyperglycemia-induced unilateral basal ganglion lesions with and without hemichorea A PET study. Journal of Neurology.2004; 251(12): 1486-90.
[3]	Pinsker JE, Shalileh K, Rooks VJ, Pinsker RW. Hemichorea-Hemiballismus Secondary to Non-Ketotic Hyperglycemia. Journal of clinical medicine research. Elmer Press; 2015.
[4]	Mittal P. Hemichorea hemiballismus syndrome: the first presentation of type 2 diabetes mellitus as a rare cause of chorea. Iranian journal of radiology: a quarterly journal published by the Iranian Radiological Society. 2011.
[5]	Pasquel FJ, Umpierrez GE. Hyperosmolar Hyperglycemic State: A Historic Review of the Clinical Presentation, Diagnosis, and Treatment. Diabetes Care. American Diabetes Association; 2014.
[6]	Damani AA, Ghoshal AA, Salins NA, Deodhar JA, Muckaden MA. Management of hemichorea hemiballismusus syndrome in an acute palliative care setting. Indian journal of palliative care. 2015.
[7]	Iwata A, Koike F, Arasaki K, Tamaki M. Blood brain barrier destruction in hyperglycemic chorea in a patient with poorly controlled diabetes. Journal of the Neurological Sciences. 2001.
[8]	Ray SP, Howlader SP, Chakraborty SP, Chakraborty PP, Ghosh SP. Hemichorea-Hemiballismus as the First Presentation of Type 2 Diabetes. Clinical Diabetes. 2015.
[9]	Borensztein A, Walker RH, Schell R, Guber HA. Hyperglycemia-Induced Involuntary Movements: 2 Case Reports and a Review of the Literature. AACE Clinical Case Reports. 2015; 1(3).
[10]	Roy UK, Das SK, Mukherjee AK, Biswas DK, Pan KK, Biswas AK, et al. Irreversible Hemichorea-Hemiballismus in a Case of Nonketotic Hyperglycemia Presenting as the Initial Manifestation of Diabetes Mellitus. Tremor and other hyperkinetic movements (New York, N.Y.). 2016.
[11]	Padmanabhan SS, Zagami AM, Poynten Aundefined. A Case of Hemichorea-Hemiballismusus Due to Nonketotic Hyperglycemia. Diabetes Care. 2013.
[12]	Chang CV, Felicio AC, Godeiro Jr, Matsubara LS, Duarte DR, Ferraz HB, et al. Chorea-ballism as a manifestation of decompensated type 2 diabetes mellitus. The American journal of the medical sciences. 2007.