Objective: report 2 patients with different types of movement disorders (MD) revealing an Acute hyperglycemia without ketosis (AHWK).

Background: neurological complications of diabetes are multiple, including mainly stroke, peripheral neuropathy and seizures. Therefore, MD are less frequently described. AHWK, particularly, can manifest with a wide variety of MD.

Method: a case series

Results: P1: a 73 yearsold female consulted for acute onset of MD involving the face and the left arm. They were described as involuntary, sudden, irregular, of large amplitude including the left upper limb associated with facial grimacing suggestive of choreic-ballistic movements. She had a history of a type-2 diabetes. At presentation, the patient was alert, had no headache, nor vomiting, nor fever. Her vitals were normal. Brain CT scan was normal. Laboratory tests showed high blood glucose (30,2mmol/l), uric sugar 3+ and urinary ketone (-). Few hours after adequate hydration and insulin therapy, all movements disappeared.
P2: a 66 yearold female, with a history of diabetes, presented with several episodes of facial MD. They were described as involuntary repetitive movements of facial grimacing, right eyelid twitching and neck twisting suggestive of orofacial dyskinesia and blepharospasm. Otherwise, during these episodes, the patient was conscious, her physical and neurological examination were unremarkable. Brain MRI showed T1 and T2 FLAIR hyperintensities within the left caudate nucleus. Laboratory investigation were normal except for a high blood glucose (22mmol/l) without urinary ketone. These MD rapidly ceased after an appropriate treatment with insulin.

Conclusion: we highlight, through these cases, the importance of considering treatable diseases, such as AHWK, when MD occur acutely in elderly.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/acute-hyperglycemia-without-ketosis-related-movement-disorders-a-case-series/