Endocrine Abstracts

Movement disorders as the initial symptoms of diabetes mellitus are rare. Here, we describe one of these rare manifestations of primary diabetes: a case of newly diagnosed diabetes mellitus in an old age female patient with transient monoballismus during an episode of ketotic hyperglycemia. Ballism can be rapidly controlled by normalization of glycemia. Our patient had monoballism confined to her upper extremity. To our knowledge, this is the first report describing monoballism in a patient with ketotic hyperglycemia. She had a rapid symptomatic remission after correction of the hyperglycemia.

Hemichorea-hemiballismus (HC-HB) constitute a neurological syndrome characterized by violent proximal involuntary movements on one side of the body, involving mainly the upper extremity (1). Focal epilepsy, transient chorea or ballism provoked by an episode of nonketotic hyperglycemia (NKH) in adults with type 2 diabetes (1-8), and ketotic hyperglycemia in children with type I diabetes mellitus have been reported (9). Nonketotic hyperglycemia occurs more often in women (1,3,6) and usually is associated with very high blood glucose (3). In these cases, the seizures (7) as well as the choreiform movements have resolved within days to a few weeks after normalization of blood glucose and hence, reversible metabolic derangements within the basal ganglia have often been assumed (1-4,8,9). Most of the cases have MRI changes in the putamen with high signal intensity on T1-weighted images and variable signal characteristics ranging from hyper-, to iso-, to hypo-intensity on T2-weighted images (1-3,6,8).

Movement disorders as the initial symptoms of diabetes mellitus are rare (5,8). Here, we describe one of these rare manifestations of primary diabetes: a case of newly diagnosed diabetes mellitus in an old age female patient with transient monoballismus during an episode of ketotic hyperglycemia.