BMJ Case Reports 2012; doi:10.1136/bcr-11-2011-5084
  • Rare disease

Hyperosmolar non-ketotic hyperglycaemia: an important and reversible cause of acute bilateral ballismus

  1. Andrew Nicolson1
  1. 1The Walton Centre NHS Trust, Liverpool, UK
  2. 2North Cumbria University Hospitals NHS Trust, Liverpool, UK
  3. 3The Department of Neuroscience, University of Liverpool, Liverpool, UK
  1. Correspondence to Dr Philip Milburn-McNulty, philmilburnmcnulty{at}

An 83-year-old lady with type 2 diabetes mellitus was admitted to hospital with pneumonia. After 3 days of oral amoxicillin she developed ballism-choreiform movements of all four limbs. Her serum glucose and osmolality were raised. She had no factors suggestive of genetic or iatrogenic causes. A CT scan of the brain revealed bilateral putamen hyperintensities. She was started on tetrabenazine and subcutaneous insulin, which led to complete resolution of her symptoms.


  • Competing interests None.

  • Patient consent Obtained.

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