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Medical City Weatherford
type 2 diabetes mellitus, dyskinesias, Hemichorea-hemiballismus syndrome
Endocrine System Diseases | Internal Medicine | Nervous System Diseases | Nutritional and Metabolic Diseases
Hemichorea-hemiballismus (HCHB) syndrome is a syndrome characterized by choreic movements which are irregular, nonrepetitive, and random movements and ballismus which are spontaneous, violent movements. HCHB syndrome is a rare presentation which can be precipitated by uncontrolled diabetes and is thought to have multiple plausible mechanisms. One mechanism of HCHB with uncontrolled diabetes is ischemic injury in the basal ganglia causing impaired gross motor control. Presented here is a case of HCHB syndrome initially seen on imaging and later correlated with physical examination. This patient presented for nonspecific complaints of fatigue, generalized weakness, and lower extremity weakness. On evaluation by EMS prior to arrival, she was found to be obtunded with a blood glucose of greater than 500 mg/dL and was treated with insulin in the field prior to arrival. On arrival, her mentation had improved and she was able to answer clarifying questions of noncompliance with her antihyperglycemic medications and lower extremity weakness. She had a head CT performed which showed lesions in the right caudate nucleus and putamen consistent with HCHB syndrome. She was started on treatment for nonketotic hyperglycemia with insulin. As her mentation improved, she was able to cooperate with neurological physical examination, which was positive for irregular and violent movements in the left upper and lower extremities. She had mild improvement in her hemichorea and hemiballismus with improved glycemic control and she was able to be discharged to a skilled nursing facility for further rehabilitation. She has had further hospitalizations, after initial evaluation, for poor glycemic control and repeat head CT imaging has continued to show right basal ganglia lesions. This case represents a rare complication with hemichorea-hemiballismus syndrome due to uncontrolled diabetes mellitus. HCHB syndrome associated with uncontrolled diabetes is also referred to as diabetic striatopathy and is characterized by poor glycemic control, unilateral striatal hyperdensity on CT imaging, and contralateral choreic movements. Diabetic striatopathy remains a poorly understood disease and the exact pathophysiologic mechanism has not been definitively elucidated. Antidopaminergic medications may be used to control the choreic movements of diabetic striatopathy; however, the mainstay of treatment is glycemic control, most commonly with insulin therapy.
HCA Healthcare Graduate Medical Education
Cheneler, Mark; Padhi, Tapannita; Qureshi, Khizir; and Bahrami, Carlos, "A Case of Unilateral Jerking Movements in a Patient with Uncontrolled Type 2 Diabetes Mellitus" (2023). North Texas Research Forum 2023. 36.