Joao Oliverio Ribeiro, Joao Pinto Machado, Sara Macedo, Eurico Oliveira
Abstract: Although not very frequent, chorea may be a manifestation of hyperglycaemia, more frequently on Asian elder women with type 2 Diabetes, predominantly presenting with non-ketotic hyperglycaemia. The authors present the case of a 68 years old Caucasian woman presenting with hyperglycaemia and involuntary choreiform movements of the right hemibody. The patient was not taking any medication but there was a previous Diabetes diagnosis. An initial arterial blood sample revealed a glycaemia of 459mg/dL. Insulin was initiated, and a blood sample and Cerebral CT-Scan scan were requested. The blood sample allowed the exclusion of infectious processes and the cerebral CT-Scan helped to exclude stroke, haemorrhage, tumours and other cerebral lesions. The patient was admitted due to a decompensated Diabetes Mellitus and to Choreiform movements and the diagnosis of Hyperglycaemic Chorea started to be a possibility. The patient kept the insulin administrations until normalization of the glycaemic profile. A progressive resolution of the involuntary movements was observed, with their resolution on the 3rd day of internment. The patient was discharged under medication with oral antidiabetics (metformin, a DPP4 inhibitor and a sulfonylurea). A Brain MRI revealed a light T1 hypersignal in the posterior part of the putamen, one characteristic finding of Hyperglycaemic Chorea.
Keywords: Chorea, Diabetes Complications, Diabetes Mellitus, Type 2, Hyperglycemia