1
|
Nakatsuka NJ, Nakhate V, Harrison DS, Galetta KM, Olsen AL. The case of an 85-year-old woman with subacute onset of bilateral chorea. Ann Clin Transl Neurol 2024; 11:1648-1649. [PMID: 38700068 PMCID: PMC11187951 DOI: 10.1002/acn3.52060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/16/2023] [Accepted: 01/19/2023] [Indexed: 05/05/2024] Open
Affiliation(s)
| | - Vihang Nakhate
- Harvard Medical SchoolBostonMassachusettsUSA
- Department of NeurologyBrigham and Women's HospitalBostonMassachusettsUSA
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Daniel S. Harrison
- Harvard Medical SchoolBostonMassachusettsUSA
- Department of NeurologyBrigham and Women's HospitalBostonMassachusettsUSA
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Kristin M. Galetta
- Harvard Medical SchoolBostonMassachusettsUSA
- Department of NeurologyBrigham and Women's HospitalBostonMassachusettsUSA
| | - Abby L. Olsen
- Department of NeurologyUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of NeurologyUPMCPittsburghPennsylvaniaUSA
| |
Collapse
|
2
|
Wang X, Zhang Y, Yang F, Bao S, Duan L, Jiang X. Further learning of clinical characteristics and imaging manifestations of nonketotic hyperglycemic hemichorea. J Diabetes 2024; 16:e13543. [PMID: 38584150 PMCID: PMC10999500 DOI: 10.1111/1753-0407.13543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/18/2024] [Accepted: 01/31/2024] [Indexed: 04/09/2024] Open
Abstract
OBJECTIVE To summarize the clinical characteristics and imaging manifestations of patients with nonketotic hyperglycemic hemichorea (NH-HC) and to explore the possible pathogenesis, diagnosis. and treatment of the disease in order to improve the understanding of this disease and avoid misdiagnosis. METHODS Retrospective analysis was performed on the case data of five patients with NH-HC admitted to our hospital in recent years. The patients were treated in the department of endocrinology, department of neurology, and department of neurosurgery in our hospital, respectively. Meanwhile, relevant literatures were consulted for further learning. RESULTS NH-HC is usually presented as a triad of nonketotic hyperglycemia, lateral chorea, and typical imaging manifestations of head magnetic resonance imaging or computed tomography, but the clinical manifestations are not the same, and imaging features may also be different, presenting a diversified trend in clinical practice. All five patients were given glucose-lowering drugs and improved with or without combination of drugs to control symptoms of chorea. CONCLUSION NH-HC is a rare complication of diabetes, characterized by hyperglycemia and hemichorea. How to identify the extreme situation and make fast judgment is a top priority. Timely and correct control of blood glucose is the key to the treatment, and when necessary, application of dopamine receptor antagonists in patients with combination therapy can accelerate improvement of the clinical symptoms. The prognosis of NH-HC is good, the clinician should strengthen comprehensive understanding of this disease to avoid missed diagnosis or misdiagnosis and enable patients to get more timely and effective treatment.
Collapse
Affiliation(s)
- Xiaoyu Wang
- Department of Endocrinology and MetabolismTianjin First Central HospitalTianjinChina
| | - Yuting Zhang
- Department of NeurologyTianjin First Central HospitalTianjinChina
| | - Fan Yang
- Department of NeurosurgeryTianjin First Central HospitalTianjinChina
| | - Suqing Bao
- Department of Endocrinology and MetabolismTianjin First Central HospitalTianjinChina
| | - Lijun Duan
- Department of Endocrinology and MetabolismTianjin First Central HospitalTianjinChina
| | - Xia Jiang
- Department of Endocrinology and MetabolismTianjin First Central HospitalTianjinChina
| |
Collapse
|
3
|
Chatterjee S, Ghosh R, Biswas P, Das S, Sengupta S, Dubey S, Ray BK, Pandit A, Benito-León J, Bhattacharjee R. Diabetic striatopathy and other acute onset de novo movement disorders in hyperglycemia. Diabetes Metab Syndr 2024; 18:102997. [PMID: 38582065 DOI: 10.1016/j.dsx.2024.102997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND AND AIMS Acute onset de novo movement disorder is an increasingly recognized, yet undereported complication of diabetes. Hyperglycemia can give rise to a range of different movement disorders, hemichorea-hemiballism being the commonest. This article delves into the current knowledge about this condition, its diverse presentations, ongoing debates regarding its underlying mechanisms, disparities between clinical and radiological findings, and challenges related to its management. METHODS PubMed and Google Scholar were searched with the following key terms- "diabetes", "striatopathy", "hyperglycemia", "striatum", "basal ganglia", "movement disorder", "involuntary movement". Case reports, systematic reviews, meta-analysis, and narrative reviews published in English literature related to the topic of interest from January 1, 1950, to October 20, 2023, were retrieved. The references cited in the chosen articles were also examined, and those considered relevant were included in the review. RESULTS Diabetic striatopathy is the prototype of movement disorders associated with hyperglycemia with its characteristic neuroimaging feature (contralateral striatal hyperdensitity on computed tomography or hyperintensity on T1-weighted magnetic resonance imaging). Risk factors for diabetic striatopathy includes Asian ethnicity, female gender, prolonged poor glycemic control, and concurrent retinopathy. Several hypotheses have been proposed to explain the pathophysiology of movement disorders induced by hyperglycemia. These hypotheses are not mutually exclusive; instead, they represent interconnected pathways contributing to the development of this unique condition. While the most prominent clinical feature of diabetic striatopathy is a movement disorder, its phenotypic expression has been found to extend to other manifestations, including stroke, seizures, and cognitive and behavioral symptoms. Fortunately, the prognosis for diabetic striatopathy is generally excellent, with complete resolution achievable through the use of anti-hyperglycemic therapy alone or in combination with neuroleptic medications. CONCLUSION Hyperglycemia is the commonest cause of acute onset de novo movement disorders presenting to a range of medical specialists. So, it is of utmost importance that the physicians irrespective of their speciality remain aware of this clinical entity and check blood glucose at presentation before ordering any other investigations. Prompt clinical diagnosis of this condition and implementation of intensive glycemic control can yield significant benefits for patients.
Collapse
Affiliation(s)
- Subhankar Chatterjee
- Department of Endocrinology & Metabolism, Medical College & Hospital, Kolkata, India.
| | - Ritwik Ghosh
- Department of General Medicine, Burdwan Medical College & Hospital, Burdwan, India.
| | - Payel Biswas
- Department of Radiodiagnosis, GNRC Hospitals, Barasat, Kolkata, India.
| | - Shambaditya Das
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGMER & SSKM Hospital, Kolkata, India.
| | - Samya Sengupta
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGMER & SSKM Hospital, Kolkata, India.
| | - Souvik Dubey
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGMER & SSKM Hospital, Kolkata, India.
| | - Biman Kanti Ray
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGMER & SSKM Hospital, Kolkata, India.
| | - Alak Pandit
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGMER & SSKM Hospital, Kolkata, India.
| | - Julián Benito-León
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain.
| | - Rana Bhattacharjee
- Department of Endocrinology & Metabolism, Medical College & Hospital, Kolkata, India.
| |
Collapse
|
4
|
Arecco A, Ottaviani S, Boschetti M, Renzetti P, Marinelli L. Diabetic striatopathy: an updated overview of current knowledge and future perspectives. J Endocrinol Invest 2024; 47:1-15. [PMID: 37578646 PMCID: PMC10776723 DOI: 10.1007/s40618-023-02166-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE Diabetic striatopathy (DS) is a rare complication of poorly controlled diabetes mellitus (DM), characterized by hyperglycemia associated with chorea/ballism and characteristic reversible basal ganglia abnormalities on computed tomography (CT) and/or magnetic resonance imaging (MRI). We propose a narrative review of the literature on this topic, currently unknown to most, and about which physicians should be aware. We intend to summarize, critically review, and take to mean the evidence on this disorder, describing its typical features. METHODS We searched Pubmed for English-language sources using the following keywords in the title and the abstract: diabetic striatopathy, hyperglycemic non-ketotic hemichorea/hemiballism, chorea/hemichorea associated with non-ketotic hyperglycemia, diabetic hemiballism/hemichorea, chorea, hyperglycemia, and basal ganglia syndrome. We collected scientific articles, including case reports, reviews, systematic reviews, and meta-analyses from the years 1975 to 2023. We eliminated duplicate, non-English language or non-related articles. RESULTS Older Asian women are more frequently affected. Suddenly or insidiously hemichorea/hemiballism, mainly in the limbs, and high blood glucose with elevated HbA1c in the absence of ketone bodies have been observed. Furthermore, CT striatal hyperdensity and T1-weighted MRI hyperintensity have been observed. DS is often a treatable disease following proper hydration and insulin administration. Histopathological findings are variable, and no comprehensive hypothesis explains the atypical cases reported. CONCLUSION DS is a rare neurological manifestation of DM. If adequately treated, although treatment guidelines are lacking, the prognosis is good and life-threatening complications may occur occasionally. During chorea/hemiballism, we recommend blood glucose and HbA1c evaluation. Further studies are needed to understand the pathogenesis.
Collapse
Affiliation(s)
- A Arecco
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, 16132, Genoa, Italy
| | - S Ottaviani
- Section of Geriatrics, Department of Internal Medicine and Medical Specialties, University of Genova, 16132, Genoa, Italy
| | - M Boschetti
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, 16132, Genoa, Italy.
- IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy.
| | - P Renzetti
- IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - L Marinelli
- IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, 16132, Genoa, Italy
| |
Collapse
|
5
|
Chen X, Ma C, Zhi L, Wei X, Luo J, Liang C, Tan J, Zhou H, Wu J. Hemichorea Associated With Nonketotic Hyperglycemia. J Clin Endocrinol Metab 2023; 108:e550-e556. [PMID: 36800278 DOI: 10.1210/clinem/dgad077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/18/2023]
Abstract
CONTEXT Hemichorea associated with nonketotic hyperglycemia (HC-NH) is a rare diabetic complication for which the pathogenesis remains unclear. OBJECTIVE This study reported 16 cases of HC-NH to improve the understanding of the disease and avoid misdiagnosis and missed diagnosis. METHODS Data of 16 patients with HC-NH in a single center from 2000 to 2021 were analyzed retrospectively, and the relevant literature was reviewed. RESULTS The participants (8 men and 8 women) had a mean age of 67.6 ± 16.4 years. Bilateral limbs were involved in 2 cases, and the others had hemichorea (6 in the left side and 8 in the right side). The average random blood glucose level was 17.51 ± 7.67 mmol/L, and the glycated hemoglobin A1c level was 11.9%±3.1% at admission. Eleven patients had a history of diabetes, and the other 5 patients were diagnosed with new-onset diabetes mellitus, but no remarkable differences were observed in the presentation or treatment of chorea. Ketonuria was detected in 7 patients. The basal ganglia (putamen, globus pallidus, and caudate nucleus) of 9 cases had typical hyperdensity on computed tomography and/or hyperintensity signals from magnetic resonance imaging. The chorea symptoms of 15 patients improved within 5.0 ± 1.9 days after treatment. CONCLUSION This study provides additional valuable information about the clinical and neuroimaging features of HC-NH. We hypothesize that chronic ischemia of the basal ganglia due to cerebral atherosclerosis combined with hyperglycemia is associated with HC-NH.
Collapse
Affiliation(s)
- Xiaoming Chen
- Department of Endocrinology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China
| | - Choudi Ma
- Department of Endocrinology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China
| | - Lijin Zhi
- Department of Endocrinology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China
| | - Xiaodan Wei
- Department of Endocrinology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China
| | - Jiaxin Luo
- First College of Clinical Medicine, Guangdong Medical University, Zhanjiang, 524001, China
| | - Chanbo Liang
- Department of Endocrinology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China
| | - Jieping Tan
- Department of Endocrinology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China
| | - Haihong Zhou
- Department of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China
| | - Jiayuan Wu
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China
| |
Collapse
|
6
|
Dubey S, Chatterjee S, Ghosh R, Louis ED, Hazra A, Sengupta S, Das S, Banerjee A, Pandit A, Ray BK, Benito-León J. Acute onset movement disorders in diabetes mellitus: A clinical series of 59 patients. Eur J Neurol 2022; 29:2241-2248. [PMID: 35403331 PMCID: PMC9542887 DOI: 10.1111/ene.15353] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/29/2022] [Accepted: 04/02/2022] [Indexed: 11/29/2022]
Abstract
Background and purpose No previous study has assessed the frequency and clinical–radiological characteristics of patients with diabetes mellitus (DM) and acute onset nonchoreic and nonballistic movements. We conducted a prospective study to investigate the spectrum of acute onset movement disorders in DM. Methods We recruited all the patients with acute onset movement disorders and hyperglycemia who attended the wards of three hospitals in West Bengal, India from August 2014 to July 2021. Results Among the 59 patients (mean age = 55.4 ± 14.3 years, 52.5% men) who were included, 41 (69.5%) had choreic or ballistic movements, and 18 (30.5%) had nonchoreic and nonballistic movements. Ballism was the most common movement disorder (n = 18, 30.5%), followed by pure chorea (n = 15, 25.4%), choreoathetosis (n = 8, 13.6%), tremor (n = 5, 8.5%), hemifacial spasm (n = 3, 5.1%), parkinsonism (n = 3, 5.1%), myoclonus (n = 3, 5.1%), dystonia (n = 2, 3.4%), and restless leg syndrome (n = 2, 3.4%). The mean duration of DM was 9.8 ± 11.4 years (89.8% of the patients had type 2 DM). Nonketotic hyperglycemia was frequently (76.3%) detected. The majority (55.9%) had no magnetic resonance imaging (MRI) changes; the remaining showed striatal hyperintensity. Eight patients with MRI changes exhibited discordance with sidedness of movements. Most of the patients (76.3%) recovered completely. Conclusions This is the largest clinical series depicting the clinical–radiological spectrum of acute onset movement disorders in DM. Of note was that almost one third of patients had nonchoreic and nonballistic movements. Our findings highlight the importance of a capillary blood glucose measurement in patients with acute or subacute onset movement disorders, irrespective of their past glycemic status.
Collapse
Affiliation(s)
- Souvik Dubey
- Department of Neuromedicine, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research &, SSKM Hospital, Kolkata, West Bengal, India
| | - Subhankar Chatterjee
- Department of General Medicine, Patliputra Medical College & Hospital, Dhanbad, Jharkhand, India
| | - Ritwik Ghosh
- Department of General Medicine, Burdwan Medical College, and Hospital, Burdwan, West Bengal, India
| | - Elan D Louis
- Department of Neurology, University of Texas Southwestern, Dallas, TX, United States
| | - Avijit Hazra
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research &, SSKM Hospital, Kolkata, West Bengal, India
| | - Samya Sengupta
- Department of General Medicine, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
| | - Shambaditya Das
- Department of Neuromedicine, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research &, SSKM Hospital, Kolkata, West Bengal, India
| | - Abhirup Banerjee
- Department of Endocrinology, N.R.S. Medical College & Hospital, Kolkata, West Bengal, India
| | - Alak Pandit
- Department of Neuromedicine, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research &, SSKM Hospital, Kolkata, West Bengal, India
| | - Biman Kanti Ray
- Department of Neuromedicine, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research &, SSKM Hospital, Kolkata, West Bengal, India
| | - Julián Benito-León
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Department of Medicine, Complutense University, Madrid, Spain
| |
Collapse
|
7
|
Tsalta-Mladenov ME, Georgieva DK, Andonova SP. Hyperglycemic hemichorea due to diabetic striatopathy: case-based review. Curr Med Res Opin 2022; 38:365-369. [PMID: 34873977 DOI: 10.1080/03007995.2021.2015159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Diabetic Striatopathy (DS) is a rare complication of diabetes mellitus (DM) with poor glycemic control and typical neuroimaging findings. DS predominantly leads to a unilateral reversible injury of the basal ganglia resulting in various movement disorders such as hemichorea and hemibalismus. We present a rare case of DS with left-sided hemichorea as a first presentation for a newly diagnosed Diabetes Mellitus (DM) type II and to make a thorough review of this disorder and to provide a practical approach to its management. A 63-year-old female was admitted to the neurology ward with symptoms of involuntary hyperkinetic movements for the left limbs and the left half of the face. The blood samples revealed random serum glucose of 30.8 mmol/l and an HbA1c of 15.13%. The computed tomography of the brain showed asymmetric, unilateral hyperdensity in the right basal ganglia (BG) - the putamen and nucleus caudatus. The patient was managed with Insulin and Haloperidol as the symptoms entirely resolved on the tenth day. In conclusion (DS) is a condition with a good prognosis and reversible clinical and neuroimaging findings after a prompt diagnosis and management. DS should be considered a possible differential diagnosis in patients with abrupt onset of hyperkinetic movement disorders.
Collapse
Affiliation(s)
- Mihael Emilov Tsalta-Mladenov
- Department of Neurology and Neuroscience, Faculty of Medicine, Medical University "Prof. Paraskev Stoyanov", Varna, Bulgaria
- Second Clinic of Neurology with ICU and Stroke Unit, University Hospital "St. Marina", Varna, Bulgaria
| | - Darina Kirilova Georgieva
- Department of Neurology and Neuroscience, Faculty of Medicine, Medical University "Prof. Paraskev Stoyanov", Varna, Bulgaria
- Second Clinic of Neurology with ICU and Stroke Unit, University Hospital "St. Marina", Varna, Bulgaria
| | - Silva Peteva Andonova
- Department of Neurology and Neuroscience, Faculty of Medicine, Medical University "Prof. Paraskev Stoyanov", Varna, Bulgaria
- Second Clinic of Neurology with ICU and Stroke Unit, University Hospital "St. Marina", Varna, Bulgaria
| |
Collapse
|
8
|
Maia M, Moreira AP, Gonçalves AI, Espírito Santo J, Araújo J. Hemichorea-Hemiballism as a Manifestation of Hyperglycemia. Cureus 2021; 13:e19330. [PMID: 34909293 PMCID: PMC8653868 DOI: 10.7759/cureus.19330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2021] [Indexed: 12/04/2022] Open
Abstract
Hemichorea-hemiballism associated with hyperglycemia is a syndrome characterized by a sudden occurrence of hemichorea, or its more severe expression hemiballism, in patients with non-ketotic hyperglycemia. Hemichorea-hemiballism tends to occur more commonly among elderly people and women of Asian origin. The authors present two rare cases of patients who manifested choreiform and ballistic movements of the limbs and concomitant non-ketotic hyperglycemia. Radiological findings were congruent with hyperglycemia etiology. These cases show that it is important to be aware of hemichorea-hemiballism associated with hyperglycemia, as there is a possible treatment and, if detected early on, a direct impact on prognosis.
Collapse
Affiliation(s)
- Maria Maia
- Internal Medicine, Hospital Beatriz Ângelo, Lisboa, PRT
| | | | | | | | - José Araújo
- Internal Medicine, Hospital Beatriz Ângelo, Lisboa, PRT
| |
Collapse
|
9
|
Rodríguez LÁ, Sipión J, Jara W. HEMICOREA-HEMIBALISMO TRANSITORIO SECUNDARIO A CRISIS HIPERGLUCÉMICA. REPORTE DE CASO Y REVISIÓN DE LA LITERATURA. REVISTA MÉDICA CLÍNICA LAS CONDES 2021. [DOI: 10.1016/j.rmclc.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
10
|
Majeed MS, May J, Ahmed FW, Chakera AJ. Diabetic hemiballismus in the context of euglycaemia. PRACTICAL DIABETES 2021. [DOI: 10.1002/pdi.2332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Muhammad Shakeel Majeed
- Specialist Registrar in Diabetes and Endocrinology, Saint George's University Hospital, Tooting London UK
| | - Julie May
- Diabetes Nurse Specialist, Royal Sussex County Hospital University Hospitals Sussex NHS Foundation Trust UK
| | - Fahad Wali Ahmed
- Consultant, Diabetes and Endocrinology, Royal Sussex County Hospital University Hospitals Sussex NHS Foundation Trust UK
| | - Ali J Chakera
- Consultant, Diabetes and Endocrinology University Hospitals Sussex NHS Foundation Trust; Honorary Senior Lecturer, Brighton and Sussex Medical School UK
| |
Collapse
|
11
|
Fatima M, Iqbal M, Abbas S, Kumar D, Jitidhar F. A Rare Case of Hyperglycemic-Hemichorea in a Young Patient. Cureus 2020; 12:e8483. [PMID: 32642387 PMCID: PMC7336583 DOI: 10.7759/cureus.8483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Chorea is an abnormal, nonrhythmic, and purposeless movement of limbs. There is a long list of diseases responsible for chorea; long-standing hyperglycemia can sometimes result in it, which typically manifests on one side of the body. MRI brain is an added diagnostic tool, which commonly shows hyperintense basal ganglia lesion on T1-weighted images. Chorea in the context of hyperglycemia is a reversible and infrequent occurrence, best managed with insulin and haloperidol combination therapy. Here, we discuss a patient with hyperglycemic-hemichorea, whose symptoms resolved completely within two months of taking insulin and haloperidol.
Collapse
Affiliation(s)
- Meraj Fatima
- Neurology, Dow International Medical College, Dow University Hospital, Dow University of Health Sciences, Karachi, PAK
| | - Mohsin Iqbal
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK.,Internal Medicine, Dow University Hospital, Karachi, PAK
| | - Saira Abbas
- Neurology, Dow University of Health Sciences, Karachi, PAK
| | - Deepak Kumar
- Internal Medicine: Nephrology, Jinnah Postgraduate Medical Center, Karachi, PAK
| | - Fnu Jitidhar
- Internal Medicine, Dow Medical College/ Civil Hospital, Karachi, PAK
| |
Collapse
|
12
|
Yelam A, Nagarajan E, Digala LP, Bollu PC. Hyperglycaemic chorea-ballism or unmasking of Huntington's chorea in a patient with diabetes. BMJ Case Rep 2020; 13:13/3/e232726. [PMID: 32188607 DOI: 10.1136/bcr-2019-232726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Chorea-ballism is a neurological syndrome characterised by violent involuntary movements of one or both extremities. In the last decades, several patients with these involuntary movements were reported in association with hyperglycaemia. Here, we present a unique case of possible Huntington's disease, which could have been unmasked by the hyperglycaemic insult to the basal ganglia in a 64-year-old man who presented with chorea-ballism.
Collapse
Affiliation(s)
- Anudeep Yelam
- Neurology, University of Missouri Health Care, Columbia, Missouri, USA
| | | | | | - Pradeep C Bollu
- Neurology, University of Missouri Health Care, Columbia, Missouri, USA
| |
Collapse
|
13
|
Chorea/ballism secondary to non-ketotic hyperglycaemia: report of 4 cases. NEUROLOGÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.nrleng.2019.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
14
|
"Diabetic striatopathy": clinical presentations, controversy, pathogenesis, treatments, and outcomes. Sci Rep 2020; 10:1594. [PMID: 32005905 PMCID: PMC6994507 DOI: 10.1038/s41598-020-58555-w] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 01/07/2020] [Indexed: 11/08/2022] Open
Abstract
Diabetic striatopathy (DS) is a rare medical condition with ambiguous nomenclature. We searched PubMed database from 1992 to 2018 for articles describing hyperglycemia associated with chorea/ballism and/or neuroimages of striatal abnormalities. Descriptive analysis was performed on demographic/clinical characteristics, locations of striatal abnormalities on neuroimages, pathology findings, treatment strategies, and outcomes. In total, 176 patients (male:female = 1:1.7) were identified from 72 articles with mean age 67.6 ± 15.9 (range, 8-92). Among them, 96.6% had type 2 DM with 17% being newly diagnosed. Average blood glucose and glycated hemoglobin concentrations were 414 mg/dL and 13.1%, respectively. Most patients (88.1%) presented with hemichorea/hemiballism. Isolated putamen and combined putamen-caudate nucleus involvements were most common on neuroimaging studies with discrepancies between CT and MRI findings in about one-sixth of patients. Unilateral arm-leg combination was the most frequent with bilateral chorea in 9.7% of patients. Chorea and imaging anomalies did not appear concomitantly in one-tenth of patients. Successful treatment rates of chorea with glucose-control-only and additional anti-chorea medications were 25.7% and 76.2%, respectively, with an overall recurrence rate being 18.2%. The most commonly used anti-chorea drug was haloperidol. To date, four out of six pathological studies revealed evidence of hemorrhage as a probable pathogenesis.
Collapse
|
15
|
Kim R, Cho HJ, Lee HW, Jun JS. Combined Hemichorea and Seizures in a Patient with Nonketotic Hyperglycemia. J Mov Disord 2019; 13:72-73. [PMID: 31694355 PMCID: PMC6987521 DOI: 10.14802/jmd.19058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 09/23/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ryul Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Hee-Jin Cho
- Department of Neurology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ho-Won Lee
- Department of Neurology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.,Brain Science and Engineering Institute, Kyungpook National University, Daegu, Korea
| | - Jin-Sun Jun
- Department of Neurology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| |
Collapse
|
16
|
Ryan C, Ahlskog JE, Savica R. Hyperglycemic chorea/ballism ascertained over 15 years at a referral medical center. Parkinsonism Relat Disord 2017; 48:97-100. [PMID: 29305082 DOI: 10.1016/j.parkreldis.2017.12.032] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 12/05/2017] [Accepted: 12/27/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe chorea/ballism triggered by a hyperglycemic event. METHODS We used the electronic records system at Mayo Clinic-Rochester to identify patients diagnosed with chorea or ballism from January 1st, 2000 through December 31st, 2014. Each record was reviewed to confirm chorea/ballism. From these cases we selected those that developed chorea/ballism within a month after a hyperglycemic episode (blood glucose >300 mg/dL). Clinical, laboratory, and imaging findings were analyzed. RESULTS Of the 596 chorea cases, we identified 7 patients (5 women) whose chorea was preceded by a hyperglycemic episode (range 3-30 days) during 15 years of surveillance, including new-onset diabetes in four cases. Median age was 80 years (range, 53-86). The chorea/ballism was unilateral in 6/7 cases and half of these unilateral cases had contralateral putamen T1-hyperintensity on brain MRI. After glucose correction, the chorea resolved within one week without recurrence in only one case. Among the 6 cases with persistent chorea, it was controlled with dopamine blocking/depleting medications. CONCLUSIONS Chorea triggered by hyperglycemia is a rare complication of diabetes, with only seven cases identified at our tertiary medical center during 15 years of surveillance. This comprised about 1% of all chorea cases at our center during this time. Hyperglycemic chorea primarily developed in later life, with new-onset diabetes in the majority (4/7). Although MRI putamen T1-hyperintensity is reportedly typical, it was only seen in 3/6 cases. This MRI appearance may be mistaken for a hemorrhagic stroke, given the usual unilateral presentation. The chorea was controlled with dopamine blocking/depleting medications.
Collapse
Affiliation(s)
- Conor Ryan
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - J Eric Ahlskog
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, MN, United States.
| |
Collapse
|
17
|
González-Pinto González T, Pérez Concha T, Losada Domingo JM, Moreno Estébanez A. Chorea/ballism secondary to non-ketotic hyperglycaemia: Report of 4 cases. Neurologia 2017; 35:134-136. [PMID: 29277521 DOI: 10.1016/j.nrl.2017.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 09/24/2017] [Accepted: 09/29/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - T Pérez Concha
- Servicio de Neurología, Hospital Universitario de Cruces, Barakaldo, Vizcaya, España
| | - J M Losada Domingo
- Servicio de Neurología, Hospital Universitario de Cruces, Barakaldo, Vizcaya, España
| | - A Moreno Estébanez
- Servicio de Neurología, Hospital Universitario de Cruces, Barakaldo, Vizcaya, España
| |
Collapse
|
18
|
Abstract
INTRODUCTION This is a unique case of nonketotic hyperglycemic (NKH) chorea in 84-year-old Asian woman. The patient had a history of type 2 diabetes mellitus more than 30 years, but had a poor control of blood sugar. She complained of acute onset of bilateral limb involuntary activities, and being easy to fall within a week. Laboratory testing disclosed hyperglycemia (669 mg/dL), glycated hemoglobin (14%), and normal ketones. The brain computed tomography scan and magnetic resonance imaging did not disclose any abnormality in the basal ganglion unlike most cases. The patient was then diagnosed with NKH chorea. Her symptoms improved quickly. CONCLUSIONS NKH chorea with normal imaging may represent a new subtype.
Collapse
|
19
|
Das L, Pal R, Dutta P, Bhansali A. "Diabetic striatopathy" and ketoacidosis: Report of two cases and review of literature. Diabetes Res Clin Pract 2017; 128:1-5. [PMID: 28431304 DOI: 10.1016/j.diabres.2017.03.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 03/04/2017] [Accepted: 03/13/2017] [Indexed: 12/17/2022]
Abstract
"Diabetic striatopathy" is characterized by dyskinesias with basal ganglia hyperintensities on neuroimaging. It is usually reported in elderly females with hyperglycemic hyperosmolar state and rare in patients with diabetic ketoacidosis. Here, we report two young males with diabetic ketoacidosis presenting as striatopathy, along with review of literature.
Collapse
Affiliation(s)
- Liza Das
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rimesh Pal
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Pinaki Dutta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Anil Bhansali
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| |
Collapse
|
20
|
Abd-Samat AH, Embong H. Hemichorea Hemiballismus in a Patient with Hyperglycaemic Hyperosmolar State, A Reversible Neurological Outcome of Metabolic Disorder. HONG KONG J EMERG ME 2017; 24:93-95. [DOI: 10.1177/102490791702400208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Hemichorea-hemiballismus (HCHB) is a spectrum of involuntary, non-rhythmic movement affecting one side of the body. Although rare, it has been reported as a presenting feature in hyperglycaemic hyperosmolar state (HHS) known in literature as C-H-BG (chorea, hyperglycaemia, basal ganglia) syndrome. We present a case in which the patient presented with 2-day history of right-sided hemichorea preceded by non-compliance to oral hypoglycaemic agent. Investigations revealed marked hyperosmolarity and hyperglycaemia, consistent with HHS. Computed tomography (CT) brain showed non-enhancing hyperdensities at the contralateral putaminal region. The choreiform improved after initiation of treatment for HHS. The hemichorea-hemiballistic movement can be the presenting feature of HHS, diabetic ketoacidosis or uncontrolled diabetes and is completely reversible with timely management. Nevertheless, CT brain plays diagnostic role and important to rule other more sinister aetiologies. The diagnosis of C-H-BG syndrome should be considered in patients with abnormal movement and hyperglycaemia. The symptom can completely recover if the hyperglycaemia is treated accordingly.
Collapse
|
21
|
Kim YJ, Kim SJ, Kim J, Kim MJ, Kim KJ, Yoon H, Kim SR, Chung SJ. Chorea due to diabetic hyperglycemia and uremia: distinct clinical and imaging features. Mov Disord 2015; 30:419-22. [PMID: 25649292 DOI: 10.1002/mds.26148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 12/15/2014] [Accepted: 12/21/2014] [Indexed: 11/06/2022] Open
Abstract
This study was undertaken to describe the clinical and imaging characteristics of patients with chorea associated with nonketotic hyperglycemia (C-NKH) in comparison with patients with chorea associated with uremia (C-URE). We retrospectively analyzed the clinical data of consecutive 10 C-NKH and five C-URE patients who were treated between January 1, 2001 and January 31, 2013. Women were more frequently affected by C-NKH (70% vs. 30%) and C-URE (80% vs. 20%) compared with men. The C-NKH patients demonstrated T1-hyperintense and inhomogeneous lesions in the basal ganglia, whereas C-URE patients demonstrated T2-hyperintense and homogeneous lesions in the basal ganglia. The mean time for chorea resolution after treatment was significantly shorter in C-NKH patients than in C-URE patients (4.4 ± 2.6 d vs. 73.8 ± 14.2 d, respectively; P = 0.005). The clinical and imaging features are remarkably different between C-NKH and C-URE patients, suggesting distinct pathogenic mechanisms.
Collapse
Affiliation(s)
- Young Jin Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Chen C, Zheng H, Yang L, Hu Z. Chorea-ballism associated with ketotic hyperglycemia. Neurol Sci 2014; 35:1851-5. [PMID: 25262066 DOI: 10.1007/s10072-014-1968-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
Abstract
Chorea-ballism is a rare movement disorder characterized by irregular, poorly patterned, and involuntary movements, which are usually unilateral but may be bilateral or involve the extremities. The most common metabolic cause of transient chorea-ballism is nonketotic or ketotic hyperglycemia (NKHG or KHG, respectively). A meta-analysis and several reviews have identified clinical characteristics of NKHG-associated chorea-ballism; however, the characteristics of KHG-associated chorea-ballism remain unknown. We performed a search for studies of patients with KHG-associated chorea-ballism, published in MEDLINE between 1960 and May 2014, and identified 13 studies of 15 patients. Despite the limited number of cases, we identified some significant differences in the clinical and radiological characteristics between patients with KHG- or NKHG-induced chorea-ballism. Patients with KHG were significantly younger than patients with NKHG, and a higher percentage of patients with KHG had atypical or negative brain imaging findings for chorea-ballism compared to patients with NKHG. We recommend that blood glucose levels be tested on admission as a key diagnostic measure, to improve the early diagnosis of chorea-ballism. The best treatment for KHG-induced chorea-ballism is rapid glucose control with an insulin drip and, possibly, neuroleptics. The mechanisms of the disease are unclear, although the GABA theory, cerebrovascular insufficiency, and alterations of dopaminergic activity in the striatum might play important roles.
Collapse
Affiliation(s)
- Chunli Chen
- Department of Neurology, Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | | | | | | |
Collapse
|
23
|
Yassin AM, Shroff S, Patel SD, Paker AM, Berman MA, Jackson GR. Hemichorea in a patient with diabetic ketoacidosis. J Neurol Sci 2014; 342:189-91. [PMID: 24857350 DOI: 10.1016/j.jns.2014.04.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 03/26/2014] [Accepted: 04/24/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Chorea is a common presenting feature of metabolic disorders, including nonketotic hyperglycemia in patients with type 2 diabetes mellitus, but rarely has been reported in diabetic ketoacidosis, hypothyroidism and vitamin B12 deficiency. METHODS Review the literature for reported cases of chorea as a presenting manifestation in metabolic disorders. RESULTS We report a case of hemichorea in a patient with type 2 diabetes mellitus complicated by diabetic ketoacidosis. The patient had a two day history of right sided hemichorea and decreased level of consciousness. Initial laboratory studies revealed hyperglycemia, ketosis and an anion gap metabolic acidosis consistent with diabetic ketoacidosis. Once treatment was started the choreiform movements significantly improved over three weeks. CONCLUSION Although DKA has been rarely reported as a trigger for chorea, it should be in the differential diagnosis of a patient presenting with an acute chorea. Given the reversible nature of this disease, early recognition and treatment are imperative.
Collapse
Affiliation(s)
- Ahmed M Yassin
- The University of Texas Medical Branch, Galveston, TX, United States
| | - Sheetal Shroff
- The University of Texas Medical Branch, Galveston, TX, United States.
| | - Shreshta D Patel
- The University of Texas Medical Branch, Galveston, TX, United States
| | - Asif M Paker
- Massachusetts General Hospital, Boston, MA, United States
| | - Megan A Berman
- The University of Texas Medical Branch, Galveston, TX, United States
| | | |
Collapse
|
24
|
Abstract
This is a unique case of nonketotic hyperglycemic (NKH) chorea in a 34-year-old white male. The patient had a poorly controlled type 2 diabetes mellitus (DM) due to medication incompliance. He complained of polyuria, polydipsia, and weight loss of 20 pounds within a month before presentation. T2-weighted (T2W) MRI showed hyperintensity in the left basal ganglion. Glycated hemoglobin (HBA1c) was 13.6%. The patient was started on insulin and clonazepam and the chorea resolved after proper control of the glucose level. To our knowledge, this is the first reported case of NKH chorea in a young white male with high T2-weighted (T2W) magnetic resonance signal in the basal ganglia.
Collapse
|
25
|
Abstract
PURPOSE OF REVIEW Chorea is a relatively common movement disorder that can be caused by a large variety of structural, autoimmune, neurodegenerative, pharmacologic, and metabolic disturbances of basal ganglia function. The diagnosis is rarely indicated by the phenotypic appearance of chorea and can be challenging, with many patients remaining undiagnosed. This review highlights salient features that may be observed or elicited in the case of a person with chorea, which may provide an indication of the diagnosis. RECENT FINDINGS Recent advances in genetics have identified genes for new disorders and expanded the phenotype of recognized conditions. New therapies include tetrabenazine, a presynaptic dopamine depleter, and deep brain stimulation. SUMMARY Clues to diagnosis may be found in the patient's family or medical history, on neurologic examination, or upon laboratory testing and neuroimaging. While most therapies at present are supportive, correct diagnosis is essential for appropriate genetic counseling and ultimately for future molecular therapies.
Collapse
|
26
|
Taboada GF, Lima GAB, Castro JEC, Liberato B. Dyskinesia associated with hyperglycemia and basal ganglia hyperintensity: report of a rare diabetic complication. Metab Brain Dis 2013; 28:107-10. [PMID: 23154926 DOI: 10.1007/s11011-012-9357-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 11/05/2012] [Indexed: 11/30/2022]
Abstract
The syndrome of dyskinesia associated with hyperglycemia and basal ganglia hyperintensity on T1 - weighted MR images is rare and most often affects elderly patients with type 2 diabetes. We report a case of a 79 year-old female patient who presented to the ED with a 12 h history of a left sided hemichoreoathetosis. Laboratory results revealed pronounced nonketotic hyperglycemia [27 mmol/L (486 mg/dL); HbA1c 140 mmol/mol (15 %)] and brain MRI showed bilateral T1 hyperintensity in the basal ganglia, more noticeable on the right side. One week before she had been admitted with a diagnosis of transient ischemic attack consisting in left hemiparesthesia, also with nonketotic hyperglycemia [38.9 mmol/L (700 mg/dL)] and was discharged home with partial correction of her metabolic disturbance. The movement disorder did not improve with adequate glycemic control so haloperidol was started. Six weeks later she was seen on an outpatient basis. She still had minimal residual involuntary movements of the left arm and leg. Laboratory exams revealed a well controlled diabetes mellitus [glycemia 6.0 mmol/L (109 mg/dL), HbA1c 57 mmol/mol (7.4 %)]. In conclusion, the syndrome of dyskinesia associated to hyperglycemia and hyperintensity in the basal ganglia on T1 - weighted MR images is a rare, intriguing and yet incompletely understood complication of diabetes mellitus. The increasing number of reported cases may help to better understand its peculiarities such as the existence of a clear clinical radiological dissociation and to unveil pathophysiological aspects. We suggest the possibility that the metabolic disturbances unmask a previous established asymptomatic striatum vasculopathy.
Collapse
Affiliation(s)
- Giselle F Taboada
- Endocrinology Unit-Internal Medicine Department, Universidade Federal Fluminense, Rua Marquês do Paraná 303, Niterói, Rio de Janeiro, Brazil.
| | | | | | | |
Collapse
|
27
|
Guerrero WR, Okun MS, McFarland NR. Encephalopathy, hypoglycemia, and flailing extremities: a case of bilateral chorea-ballism associated with diabetic ketoacidosis. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2013; 2. [PMID: 23439397 PMCID: PMC3569973 DOI: 10.7916/d8rx99t2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 10/28/2011] [Indexed: 12/01/2022]
Abstract
Background Hypo/hyperglycemia is a known cause of chorea and hemiballism. The temporallobes, hippocampus, basal ganglia, and substantia nigra are most susceptible to hypoglycemic changes. Methods We present a caseof bilateral chorea and bi-ballism accompanied by encephalopathyin the setting of severe hypoglycemia and diabetic ketoacidosis. The patient had brain MRI changes involving both caudate nuclei, temporal lobes, and hippocampi. Discussion This case demonstrates the basal ganglia's vulnerability to hypoglycemia and the need for cautious evaluation of involuntary movements when they occur in the setting of encephalopathy.
Collapse
Affiliation(s)
- Waldo R Guerrero
- University of Florida, Department of Neurology, Center for Movement Disorders & Neurorestoration, Gainesville, Florida, United States of America
| | | | | |
Collapse
|
28
|
Hashimoto KI, Ito Y, Tanahashi H, Hayashi M, Yamakita N, Yasuda K. Hyperglycemic chorea-ballism or acute exacerbation of Huntington's chorea? Huntington's disease unmasked by diabetic ketoacidosis in type 1 diabetes mellitus. J Clin Endocrinol Metab 2012; 97:3016-20. [PMID: 22745234 DOI: 10.1210/jc.2012-1190] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CONTENT Hyperglycemic chorea-ballism is predominantly observed in older type 2 diabetic patients, and it is rare in type 1 diabetes and diabetic ketoacidosis (DKA). Huntington's disease (HD) is one of several genetic syndromes associated with diabetes, although the reported prevalence of the association varies. There are few opportunities for most physicians to diagnose early-stage HD. OBJECTIVE We describe bilateral hyperglycemic chorea-ballism in a 40-yr-old female type 1 diabetes patient with DKA and HD. SETTING The study was conducted in a tertiary care referral hospital. RESULTS On admission, the patient exhibited severe involuntary movement of bilateral extremities with DKA, and hyperglycemic chorea-ballism was diagnosed. She recovered from chorea-ballism with admission of fluids and insulin, but mild choreatic movement persisted in the upper extremities. Brain magnetic resonance imaging and DNA analysis revealed HD. Although it has been considered that depletion of striatal γ-aminobutyric acid (GABA) content is rare in DKA, it is largely decreased in HD. Therefore, it is probable that hyperglycemic chorea-ballism or exacerbation of Huntington's chorea resulted from transient depletion of GABA. CONCLUSION The present case provides important insights on the role of GABA in hyperglycemic chorea-ballism and on the clinical issues associated with HD diagnosis.
Collapse
Affiliation(s)
- Ken-ichi Hashimoto
- Department of Endocrinology and Internal Medicine, Matsunami General Hospital, 185-1, Dendai, Kasamatsu, Gifu, MZ 501-6062, Japan
| | | | | | | | | | | |
Collapse
|