Objective: We would like to present two diabetic patients with rare motor symptomatology.

Background: Diabetes may coexist with some movement disorders. There is increasing body of evidence regarding acute onset of hemichorea in hyperketotic hyperglycemia, but evidence regarding ataxia in latent autoimmune diabetes mellitus in adults (LADA) is still sparse.

Methods: Clinical study of two cases.

Results: Case 1: 46-years old male with poor controlled diabetes mellitus type 2 was admitted to the Department of Neurology after acute onset of left-sided hemichorea-hemibalism syndrome. At the beginning of the symptoms, the patient had been hospitalized in the department of internal medicine because of non-ketotic hyperglycemia with glucose level above 600mg%. Brain computed tomography (CT) at admission and magnetic resonance imaging (MRI) performed 5 days later, had revealed an area of hyperdensity/hyperintensity affecting the right striatum. Despite normalization of glucose levels, the involuntary movements persisted. Haloperidol had been introduced and further replaced by tiapride, with satisfactory but not complete resolution of the chorea. The symptoms had resolved totally after 12 months of treatment. Case 2: 69-years old female patient was admitted to the Department of Neurology because of dizziness, diplopia, nystagmus and severe gait ataxia. Symptoms developed during couple of weeks. The patient had 20-year history of LADA. At admission, she had presented severe cerebellar symptoms with direction-changing nystagmus, dysmetria of four limbs, ataxic gait and cerebellar speech. Magnetic resonance imaging (MRI) was negative. Autoimmune laboratory examinations showed remarkably increased serum and CSF levels of antibodies against glutamic acid decarboxylase (anti-GAD ab). The patient had received treatment with intravenous immunoglobulins with good response and marked clinical improvement. In an one-year follow-up the outcome was good.

Conclusions: Acute or subacute onset of movement disturbances in patients with diabetes should increase vigilance to atypical causes of the medical problem. Especially in the second case described here the delay of diagnosis may decrease the chance to good outcome.

Dogan VB. An anti-GAD autoantibody-associated cerebellar syndrome case: a curable cause of ataxia. Neurol Sci. 2015;36:1929-31. Pinsker JE, Shalileh K, Rooks VJ, Pinsker RW. Hemichorea-Hemiballism Secondary to Non-Ketotic Hyperglycemia. J Clin Med Res. 2015;7:729-30.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/movement-disorders-in-diabetes-report-of-two-cases/