Endocrine Abstracts

Background: Non-ketotic hyperglycemia hemichorea is a movement disorder characterized by irregular, involuntary and abrupt hyperkinetic movements caused by hyperglycemia. The pathophysiology remains unclear however there are several theories on its mechanism. The diagnosis is confirmed by presence of involuntary irregular movements combined with findings of hyperdensities on the basal ganglia in cranial computed tomography scan (CT-scan) or magnetic resonance imaging scan (MRI). Pharmacologic goals of treatment include control of hyperglycemia and involuntary movements with several medications including anti-psychotics, GABA-receptor agonists, selective serotonin reuptake inhibitors or dopamine-depleting agents.

Case Presentation: A 74-year-old male known diabetic was admitted with complaints of involuntary movements on the left extremities accompanied by right sided facial spasms. The patient presented with elevated blood glucose on admission with a random blood sugar of 439 g/dl and an HbA1c level of 13.2%. He was admitted as a case of a post stroke seizure versus cerebrovascular infarct with poorly controlled Type 2 Diabetes Mellitus. A cranial computed tomography (CT-scan) was done which showed hyperdense lesions on the right caudate head. The post-stroke seizure was also confirmed by the presence of epileptiform discharges from the right frontal region on electroencephalogram (EEG). The patient’s treatment focused on blood glucose control and anti-seizure medications. There was resolution of symptoms after blood glucose was controlled.

Conclusion: Nonketotic-Hyperglycemic hemichorea is a rare and poorly understood neurologic complication of Diabetes Mellitus. Control of blood glucose combined with pharmacologic therapy to control involuntary movements remain superior in management of symptoms with good prognosis.