1
|
Isayli I, Ulloa N, Childress J. Consideration for Hemiballismus in the Differential Diagnosis: A Rare Case of Hyperosmolar Hyperglycemic State. Cureus 2022; 14:e27416. [PMID: 36051743 PMCID: PMC9419993 DOI: 10.7759/cureus.27416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 12/03/2022] Open
Abstract
We present a case of a 58-year-old male with a past medical history of hypertension and diabetes mellitus presenting to the emergency department with a complaint of abnormal and uncontrollable right arm jerking motions occurring since the afternoon on the day prior to presentation. Arm movements such as these may be consistent with either focal seizures or hemiballismus, a movement disorder classified as a choreiform subtype consisting of involuntary violent movements of an extremity with wide amplitudes. Although oftentimes focal seizures and hemiballismus are associated with neurologic etiologies such as strokes, the second most common cause of hemiballismus appears to be non-ketotic hyperosmolar hyperglycemia. While symptomatic treatment in managing focal seizures and hemiballismus may consist of benzodiazepines and dopamine receptor antagonists, respectively, it is important to treat the underlying cause, which in this case was the non-ketotic hyperosmolar hyperglycemic state associated with this patient’s long-standing history of poorly controlled diabetes mellitus.
Collapse
|
2
|
Hong AS, Kontzialis M. T2-FLAIR Hypointense White Matter Signal in Non-Ketotic Hyperglycemic Seizures. Neurohospitalist 2022; 12:577-578. [DOI: 10.1177/19418744221092257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Alex S. Hong
- Department of Radiology, Northwestern Medicine, Chicago, IL, USA
| | | |
Collapse
|
3
|
Chatterjee S, Ghosh R, Ojha UK, Diksha, Biswas P, Benito-León J, Dubey S. Recurrent Facial Focal Seizures With Chronic Striatopathy and Caudate Atrophy-A Double Whammy in an Elderly Woman With Diabetes Mellitus. Neurohospitalist 2022; 12:147-150. [PMID: 34950404 PMCID: PMC8689538 DOI: 10.1177/19418744211035370] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Seizures and involuntary movements are relatively rare, but well-known neurological complications of non-ketotic hyperglycemia. While hemichorea-hemiballism secondary to diabetic striatopathy is increasingly being reported, unilateral caudate atrophy resulting from chronic vascular insufficiency/insult in a backdrop of poorly controlled diabetes mellitus is sparsely described in literature. We herein report a 75-year-old woman with poorly controlled diabetes mellitus who presented with concurrent epilepsia partialis continua involving left side of her face and hemichorea on the right side in the context of non-ketotic hyperglycemia. Neuroimaging revealed a space-occupying lesion suggestive of low-grade glioma in the right superior frontal cortex and left-sided caudate atrophy as well. Possibly, space-occupying lesion in motor cortex acted as an inciting factor for seizures and non-ketotic hyperglycemia further lowered the seizures threshold. On the other hand, atrophied left caudate had led to persistent choreiform movements secondary to chronic uncontrolled hyperglycemia. The simultaneous presence of acute and chronic neurological complications of diabetes mellitus makes this case unique. It also highlights the need for strict control of blood glucose and utility of appropriate neuroimaging to rapidly diagnose and prevent further complications.
Collapse
Affiliation(s)
- Subhankar Chatterjee
- Department of General Medicine, Patliputra Medical College & Hospital, Dhanbad, Jharkhand, India
| | - Ritwik Ghosh
- Department of General Medicine, Burdwan Medical College & Hospital, Burdwan, West Bengal, India
| | - Umesh Kumar Ojha
- Department of General Medicine, Patliputra Medical College & Hospital, Dhanbad, Jharkhand, India
| | - Diksha
- Department of General Medicine, Patliputra Medical College & Hospital, Dhanbad, Jharkhand, India
| | - Payel Biswas
- Department of Radiodiagnosis, Apollo Gleneagles Hospital, Kolkata, 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,Julián Benito-León, Department of Neurology, University Hospital 12 de Octubre, Avenida de Córdoba km. 5,400, Madrid 28041, Spain.
| | - Souvik Dubey
- Department of Neuromedicine, Bangur Institute of Neurosciences, Kolkata, India
| |
Collapse
|
4
|
Abstract
Recognition of the role of hyperglycaemia in seizures is vital, because they tend to refractory to antiepileptic drugs and respond to insulin therapy and hydration.
Collapse
Affiliation(s)
- A Alakkas
- Division of Neurology, Department of Neurosciences, University of California at San Diego, La Jolla, CA 92093-0021, USA
| | - P Chen
- Division of Neurology, Department of Neurosciences, University of California at San Diego, La Jolla, CA 92093-0021, USA
| | - M Chen
- Division of Neurology, Department of Neurosciences, University of California at San Diego, La Jolla, CA 92093-0021, USA
| | - K Longardner
- Division of Neurology, Department of Neurosciences, University of California at San Diego, La Jolla, CA 92093-0021, USA
| | - D E Piccioni
- Division of Neurology, Department of Neurosciences, University of California at San Diego, La Jolla, CA 92093-0021, USA
| |
Collapse
|