BMJ Case Reports 2018; doi:10.1136/bcr-2017-223429
  • Rare disease

Paediatric non-ketotic hyperglycaemic hemichorea–hemiballismus

  1. Cheryl Anne Lubaton Sacro1,2
  1. 1Department of Neurosciences, University of the Philippines Manila College of Medicine, Manila, Philippines
  2. 2Department of Pediatrics, University of the Philippines Manila College of Medicine, Manila, Philippines
  3. 3Department of Radiology, University of the Philippines Manila College of Medicine, Manila, Philippines
  1. Correspondence to Dr Cezar Thomas Reyes Suratos, ctrsuratos{at}
  • Accepted 16 March 2018
  • Published 5 April 2018


Non-ketotic hyperglycaemic hemichorea–hemiballismus (NHHH) is commonly seen among elderly Asian women with type 2 diabetes mellitus. Here, we present a case of a 16-year-old Filipina with type 1 diabetes mellitus who is poorly compliant to her medications and subsequently developed right hemichorea–hemiballismus (HH). She was initially admitted with hyperglycaemia but was negative for ketonuria or metabolic acidosis. Neuroimaging showed bilateral lentiform nuclei and left caudate hyperdensities on CT and T1-weighted hyperintensity on MRI. Blood glucose was controlled with insulin. Haloperidol and clonazepam were started for the HH with gradual resolution of symptoms in 6 weeks. This is the fifth reported case of NHHH seen among the paediatric age group. NHHH in the paediatric population is clinically and radiographically similar to NHHH seen among adults. Correction of hyperglycaemia results in clinical improvement and radiographic resolution of lesions but persistent cases may necessitate specific treatment targeted towards the abnormal movements.


  • Contributors CTRS was involved in the diagnosis of the case, drafting the work and revising it. SCU was involved in the interpretation of the radiographic findings. JAELB was involved in revising the manuscript. CALS was involved in the diagnosis of the case and final approval of the version for submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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