Rare case of hemichorea due to nonketotic hyperglycemia in an elderly male with uncontrolled diabetes

The case was reported by Ezhilkugan Ganessane, Department of Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India, and colleagues.

Nonketotic hyperglycemic hemichorea is a rare diabetes complication seen in the emergency department. it is most frequently reported in elderly women, predominantly of Asian race, having poorly controlled diabetes mellitus (DM). Patients present with a triad of hemichorea, nonketotic hyperglycemia, and contralateral basal ganglia abnormality on imaging. There is no clarity on its exact pathophysiology. However, it has a very good prognosis with early diagnosis and treatment. The condition can be reversed with control of the blood glucose.

The case, published in The Journal of Emergency Medicine, concerns a 61-year-old Asian male with uncontrolled diabetes due to medication noncompliance. He was presented to the emergency department with a history of involuntary choreiform movements involving his right upper and lower limbs for 3 days and altered mental status for 1 day.

There was no history of neck stiffness, fever, head trauma, a family history of movement disorder, or poisoning. He was not taking neuroleptic medications which could have led to chorea.

Chorea is a hyperkinetic movement disorder characterized by involuntary, rapid, and irregular contractions. Nonketotic hyperglycemic hemichorea is a rare acquired cause of chorea, which is characterized by a triad of nonketotic hyperglycemia, hemichorea, and contralateral basal ganglia imaging abnormality. The predisposing factors include advanced age, female sex, poor glucose control, and Asian ethnicity.

"Nonketotic hyperglycemic hemichorea should be included in the differential of a patient presenting with high blood glucose levels and chorea," the authors concluded. "It has an excellent prognosis with both symptoms and imaging abnormalities typically resolving completely with the restoration of normoglycemia."

Reference:

Ganessane, E., Nathan, B., Balaraman, N., Uthayakumar, A., & Karn, S. (2023). Nonketotic Hyperglycemic Hemichorea in an Elderly Male: A Case Report. The Journal of Emergency Medicine. https://doi.org/10.1016/j.jemermed.2023.04.014