Hemichorea-hemiballism in a diabetic patient with euglycemia at presentation

Abstract

Hemichorea hemiballismus syndrome (HCHB) is commonly seen in an acute setting of non ketotic hyperglycaemia. Hemichorea hemiballismus has been rarely reported in the setting of normal blood sugars in a diabetic patient. We report an 84-year-old lady who initially presented with uncontrolled diabetes and acute left hemiparesis. Imaging did not reveal any evidence of recent infarction. After sugars were normalised, five weeks later she presented with involuntary movements of left upper and lower limb. On examination, patient had left hemichorea hemiballismus. Repeat MRI brain showed right putamen hyperintensity in T1 weighted images. Venous blood glucose was 123 mg/dl (6.8 mmol/L). Patient improved significantly with haloperidol and clonazepam. In conclusion, hemichorea hemiballismus can be observed in a patient with previously uncontrolled diabetes mellitus after normalization of blood sugars akin to that seen in patients with HCHB associated with hyperglycaemia.