ABSTRACT
Hemichorea-hemiballismus (HCHB) is a rare manifestation of hyperglycaemic hyperosmolar state caused by contralateral lesion in basal ganglia. A 74-year-old, known diabetic and hypertensive woman presented with one-week history of high-grade fever and loss of consciousness associated with involuntary movement of the right upper and lower limbs for 10 hours prior to presentation. Physical examination revealed pyrexia, tachycardia and altered sensorium. Blood glucose was 53.8 mmol/l, hemoglobin A1c (Hb A1c) 9.9% and brain computed tomography (CT) scan showed cerebral atrophy with bilateral basal ganglia hyperdensities. Escherichia coli was cultured from the urine. She did well on treatment with soluble insulin, rehydration and intravenous ceftriaxone. HCHB is a rare complication seen in patients with poorly controlled diabetes mellitus. This report highlights the reversibility of the disease with prompt diagnosis and appropriate insulin treatment. HCHB should be distinguished from other intracranial pathologies.
ABSTRACT
Objective To study the clinical manifestations and neuroimaging characteristics of patients with hemichorea-hemiballismus (HC-HB) induced by nonketotic hyperglycemia. Methods The clinical data, laboratory findings and neuroimaging findings of 5 patients with HC-HB induced by nonketotic hyperglycemia who were treated in Changhai hospital of Second Military Medical University were retrospectively analyzed. The 5 patients included 4 females and 1 male, ranging 65-83 years old and averaging (76. 6±7. 2) years old. Results All the five patients presented an acute onset, with four of them having chorea or ballismus involuntary movement in unilateral limbs and face and one having generalized chore. The highest levels of blood glucose in patients at onset were 18. 6-44. 6 mmol/L (averaging[26. 6±10. 5] mmol/L), with negative urine ketone. T1-weighted imaging showed hyperintensity in contralateral basal ganglia in 4 cases and in bilateral basal ganglia in 1 case, with no edema or mass effect; most T2-weighted imaging was of isointensity. Increased protein levels and normal number of cells were observed in 3 cases in cerebrospinal fluid examination, and two of three cases had increased IgG index or 24 h intrathecal synthesis rate, which was relieved by effective control of blood glucose combined with pharmacotherapy, such as haloperidol. Conclusion Nonketotic hyperglycemia and HC-HB are the characteristics of HC-HB induced by nonketotic hyperglycemia, with hyperintensity on T1-weighted MRI imaging in the contralateral basal ganglia or in bilateral basal ganglia occasionally. Early diagnosis and proper treatment of those patients can achieve good prognoses.