Objective: To describe clinical and imaging features of a patient with diabetes mellitus who presented with progressive and delayed onset hyperglycemic chorea which is a rare manifestation.

Background: Hyperglycemia chorea is one of an uncommon manifestation of severe hyperglycemia or diabetic emergency such as hyperglycemic hyperosmolar state or diabetic ketoacidosis. It usually occurs at the time that the patient has very high blood sugar level. Delayed onset hyperglycemic chorea with progression of the symptom is rarely reported.

Method: Case report including clinical feature, magnetic resonance imaging (MRI) of patient’s brain and laboratory work up.

Results: A 52 years old man with history of long standing diabetes mellitus was referred to our center due to the problem of progressive left hemichorea. One month prior, he was admitted to community hospital for one day due to a problem of severe hyperglycemia (blood glucose 600 mg/dl). Three days after discharge, he noticed involuntary dance-liked movement beginning at left leg then gradually spread to left arm. This symptom progressed slowly. Physical examination at our institute (twenty six days after symptom onset) showed choreic movement of left arm and left leg which was more prominent at the arm. Blood glucose was 143 mg/dl. We reviewed the MRI done a few days after symptom onset which showed unilateral T1W hyperintensity with gadolinium enhancement and a small area of hypointensity without enhancement at right caudate and lentiform nucleus and T2 FLAIR hyperintensity at the T1W hypointensity area. This man was diagnosed with diabetic striatopathy with pre-existing old lacunar infarction at caudate and lentiform nucleus and subsequently treated by two-milligram haloperidol intravenous and then continued with two-milligram haloperidol orally. The chorea was substantially improved with resolution in the next few days.

Conclusion: When encountering a patient presenting with acute onset chorea and history of diabetes mellitus especially with recent episode of severe hyperglycemia or diabetic emergency, recognition of delayed onset hyperglycemic chorea is important. Early and appropriate management could reverse this condition and reduce patient’s morbidity.

References: 1. Cho HS, et al. Hemichorea after hyperglycemia correction. A case report and a short review of hyperglycemia-related hemichorea at the euglycemic state. Medicine (2018) 97:10(e0076). 2. Taboada GF, et al. Dyskinesia associated with hyperglycemia and basal ganglia hyperintensity: report of a rare diabetic complication. Metab Brain Dis 2013;28:107–10.

« Back to MDS Virtual Congress 2021

MDS Abstracts - https://www.mdsabstracts.org/abstract/progressive-and-delayed-onset-hyperglycemic-chorea-after-blood-glucose-normalization-a-case-report/