Joao Pinto Machado, Joao Ribeiro, Joana Marques, Ana Nunes, Nuno Monteiro, Marta Fonseca
Abstract: Hemichorea is characterized by involuntary non-rhythmic movements on one side of the body and can be due to brain vascular or traumatic insults and neoplasm. Hyperglycemic state is a rare, reversible cause of this condition. We present an 87-years-old-woman with a poorly controlled Type 2 Diabetes Mellitus, that complained of erratic, uncontrollable limb that lasted for 6 days. She had high glycemic values, despite her medication. The patient presented with pronounced choreiform movements of both arms and legs, more marked on the left hemibody. Her blood glucose level was 257mg/dL and had A1c hemoglobin test of 13.9 %. A brain computerized tomography showed spontaneous hyperdensity at the basal nuclei, more evident at the right, suggestive of hyperglycemic hyperosmolar sequel. She was admitted with suspect of hyperglycemic hemichorea. Brain Magnetic Resonance that showed no evidence of acute ischemic lesions and showed loss of sygnal in T2- weighed acquisitions in areas in the internal capsulae of the striae region, compatible with paramagnetic substances deposition. She started an intensive insulin therapy with symptom improvement. Hyperglycemia results in the progression of cerebral ischemia and consequent injury to central nervous system and can justify the most common magnetic resonance image changes: hyperintense signals in the contralateral putamen on T1weighted images. Despite of its unclear mechanism, the role of glycemic control to ameliorate or treat the symptoms is proved and part of the diagnosis criteria. Hyperglycemic hemichorea is mostly a clinical diagnosis that is of crucial important as its a reversible state and shouldnt be overlooked.
Keywords: Chorea, Hemichorea, Hemyballismus, Hyperglicemia, Diabetes Mellitus