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

Dr. Kamal Kant KohliWritten by Dr. Kamal Kant Kohli Published On 2023-09-12T20:00:32+05:30  |  Updated On 12 Sep 2023 2:30 PM GMT
Rare case of hemichorea due to nonketotic hyperglycemia in an elderly male with uncontrolled diabetes
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Pondicherry: In a recent case study, the researchers report a case of hemichorea involving the right upper and lower limbs due to nonketotic hyperglycemia in an elderly male. After the normalization of blood glucose, the patient's symptoms resolved.The case was reported by Ezhilkugan Ganessane, Department of Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education and...

Pondicherry: In a recent case study, the researchers report a case of hemichorea involving the right upper and lower limbs due to nonketotic hyperglycemia in an elderly male. After the normalization of blood glucose, the patient's symptoms resolved.

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


The Journal of Emergency MedicineNonketotic Hyperglycemic Hemichoreanonketotic hyperglycemiahigh blood glucose
Source : The Journal of Emergency Medicine
Dr. Kamal Kant Kohli
Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Before Joining Medical Dialogues, he has served at important positions in the medical industry in India including as the Hony. Secretary of the Delhi Medical Association as well as the chairman of Anti-Quackery Committee in Delhi and worked with other Medical Councils in India. Email: editorial@medicaldialogues.in. Contact no. 011-43720751

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