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Rare disease
CASE REPORT
Bilateral chorea/ballismus: detection and management of a rare complication of non-ketotic hyperglycaemia
  1. Venkata Sunil Bendi1,
  2. Abhishek Matta2,
  3. Diego Torres-Russotto3,
  4. James Shou1
  1. 1Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA
  2. 2Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA
  3. 3Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA
  1. Correspondence to Dr Abhishek Matta, mtarun2006{at}gmail.com

Summary

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.

  • movement disorders (other than parkinsons)
  • neuroimaging
  • neurology (drugs and medicines)
  • diabetes

https://doi.org/10.1136/bcr-2018-224856

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    Footnotes

    • Contributors AM contributed towards collecting the patient data and reviewing the literature and preparing the manuscript. VSB contributed towards collecting the data, reviewing the literature and preparing the manuscript. JS contributed towards reviewing the data, analysing the patient chart and preparing the manuscript. DT-R contributed towards proofreading the manuscript.

    • 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 Parental/guardian consent obtained.

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