Hemichorea a rare presentation of uncontrolled T2DM affecting elderly females: A case study

The patient had no history of fever, headache, vomiting, seizures, rash, drug intake, falls, and head injury and has been diagnosed with diabetes for 14 years on irregular treatment with insulin. There was no history of similar illnesses in the family. On examination, the patient was conscious, oriented, with a Glasgow Coma Scale (GCS) score of E4V5M6, blood pressure of 110/70 mmHg, respiratory rate of 20 cycles/min, SpO2 of 96% on room air, and pulse rate of 81 beats/min. The patient's bilateral pupils were reactive and of normal size and the patient had normal vesicular breath sounds. Regarding the central nervous system, choreiform movements in bilateral upper limbs and left lower limbs were observed, and the power in all four limbs was 5/5. The tone was normal, and the bilateral plantar were flexor.

In the emergency department, isotonic saline (0.9% NaCl) at the rate of 10-20 ml/kg and insulin was administered to control blood sugar levels; and haloperidol (5 mg) was intravenously injected to control the involuntary movements of the patient. The patient was discharged with clonazepam (10 mg per tablet) along with insulin (subcutaneous). The patient is now asymptomatic with regular follow-up in the neurology outpatient department.

Thus, the researchers concluded that NKH chorea is a rare complication of uncontrolled diabetes mellitus and is more commonly seen in elderly females. It is one of the reversible metabolic causes of chorea; timely recognition and appropriate treatment of this condition will improve the patient's quality of life.

Reference:

A Case of Chorea: A Rare and Unusual Complication of Hyperglycemia by Nidhi Kaeley et al. published in the Cureus.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8589335/