Hyperglycemia-induced hemichorea-hemiballismus syndrome - a systematic review.

Nonketotic hyperglycemia may occur as a cause of chorea in patients with chronic decompensated diabetes. Because it is rare and consequently poorly studied, diagnosis and treatment can be delayed. Therefore, our objective was to summarize clinical and radiological features, as well as treatments performed, from previously reported cases to facilitate adequate management in clinical practice. We searched MEDLINE/PubMed, EMBASE, Cochrane, CINAHL, Web of Science, Scopus, and LILACS databases for studies published before April 23, 2021. We included case reports and case series of adults (aged ≥ 18 years) that described hyperglycemic chorea with measurement ofglycated hemoglobin (HbA1c) and cranial magnetic resonance imaging (MRI). Studies were excluded if participants were pregnant women, aged < 18 years, and had no description of chorea and/or physical examination. We found 121 studies that met the inclusion criteria, for a total of 214 cases. The majority of the included studies were published in Asia (67.3%). Most patients were women(65.3%) aged > 65 years (67.3%). Almost all patients had decompensated diabetes upon arrival at the emergency department (97.2%). The most common MRI finding was abnormalities of the basal ganglia (89.2%). There was no difference in patient recovery between treatment with insulin alone and in combination with other medications. Although rare, hyperglycemic chorea is a reversible cause of this syndrome; therefore, hyperglycemia should always be considered in these cases.

Hyperglycemia-induced hemichorea-hemiballismus syndrome - a systematic review

ABSTRACT Nonketotic hyperglycemia may occur as a cause of chorea in patients with chronic decompensated diabetes. Because it is rare and consequently poorly studied, diagnosis and treatment can be delayed. Therefore, our objective was to summarize clinical and radiological features, as well as treatments performed, from previously reported cases to facilitate adequate management in clinical practice. We searched MEDLINE/PubMed, EMBASE, Cochrane, CINAHL, Web of Science, Scopus, and LILACS databases for studies published before April 23, 2021. We included case reports and case series of adults (aged ≥ 18 years) that described hyperglycemic chorea with measurement of glycated hemoglobin (HbA1c) and cranial magnetic resonance imaging (MRI). Studies were excluded if participants were pregnant women, aged < 18 years, and had no description of chorea and/or physical examination. We found 121 studies that met the inclusion criteria, for a total of 214 cases. The majority of the included studies were published in Asia (67.3%). Most patients were women (65.3%) aged > 65 years (67.3%). Almost all patients had decompensated diabetes upon arrival at the emergency department (97.2%). The most common MRI finding was abnormalities of the basal ganglia (89.2%). There was no difference in patient recovery between treatment with insulin alone and in combination with other medications. Although rare, hyperglycemic chorea is a reversible cause of this syndrome; therefore, hyperglycemia should always be considered in these cases.

Improvement of Hemichorea Following Surgical Resection of a Putaminal Cavernous Angioma: Case Report and Review of Literature.

BACKGROUND: Hemichorea may point to a structural lesion in the contralateral basal ganglia with a large list of possible causes. Cavernous angioma may be rarely a possible cause for acute appearance of this movement disorder. CASE DESCRIPTION: We present a rare case of a 32-year-old female patient with hemichorea caused by a cavernoma (or cavernous angioma) in the contralateral insula and putamen with complete improvement of symptoms with surgical resection of the lesion. CONCLUSIONS: We believe that surgical resection of basal ganglia cavernomas may be feasible with minor risks and resolution of clinical symptoms in the immediate postoperative period.

Síndrome de corea hiperglicemia y ganglios básales / Chorea hyperglicemia basal ganglia síndrome

Resumen La diabetes mellitus es una enfermedad de alta prevalência, así como también lo son sus complicaciones agudas. Una de ellas es el estado hiperosmolar no cetósico que raramente se asocia con alteraciones involuntarias del movimiento. Sin embargo, existe una condición que asocia alteraciones glucémicas con desórdenes del movimiento, denominado síndrome de corea hiperglicemia y ganglios basales, de la cual presentamos un caso y hacemos revisión de la literatura.

Abstract Diabetes mellitus is a disease of high prevalence, as well as its acute complications. One of them is the nonketotic hyperosmolar state that is rarely associated with involuntary changes in movement. However, there is a condition that associates glycemic alterations with movement disorders, called chorea hyperglycemia basal ganglia syndrome, of which we present a case and review the literature.

Sertraline-induced Hemichorea.

Background: Hemichorea-hemiballism is a syndrome secondary to different etiologies. Drug-induced hemichorea is a rare syndrome related to selective serotonin reuptake inhibitors. To the best of our knowledge, no previous cases of hemichorea associated with sertraline have been reported. Case Report: A 65-year-old female noticed hemichorea 1 week after initiation of sertraline. After extensive investigations, other causes of hemichorea were excluded. Hemichorea remitted after sertraline withdrawal. Discussion: In our patient, temporal association and the negative clinical assessment supported a diagnosis of likely drug-induced involuntary movement. We hypothesized that enhanced serotonergic transmission in the ventral tegmental area or nigrostriatum may be involved in sertraline-induced hemichorea.

Hemicorea vascular: una presentación infrecuente del infarto lacunar / Vascular hemichorea: a rare presentation of lacunar infarction

La corea es un trastorno hiperquinético del movimiento. Puede producirse por una gran variedad de enfermedades genéticas, infecciosas, neurodegenerativas, metabólicas, autoinmunes, estructurales o secundarias a fármacos. Es una rara manifestación de lesiones vasculares cerebrales isquémicas o hemorrágicas, afectando habitualmente un hemicuerpo y formando parte del clásico síndrome lacunar de hemicorea-hemibalismo. Presentamos el caso de un paciente de sexo masculino de 67 años de edad con factores de riesgo cardiovasculares, que se presentó con un accidente cerebrovascular a forma de hemicorea vascular. Si bien dicha presentación está descrita en toda la bibliografía, es importante por su baja frecuencia lo cual hace que la mayoría de los médicos clínicos nunca hayan estado en contacto con pacientes portadores de dicha entidad.

Chorea is a hyperkinetic movement disorder. It can be caused by a great variety of conditions: genetic, infectious, degenerative, metabolic, autoimmune, structural or related to drugs. A rare manifestation of brain vascular lesions, either isquemic or hemorrhagic, it generally affects one side of the body as part of the classic hemichorea-hemibalism lacunar syndrome. We present the case of a 67 year old male with risk factors for cardiovascular disease, admitted with the diagnosis of vascular hemichorea as the manifestation of a stroke. Although such presentation is described in most of our bibliography, it is important because of its low prevalence and, consequently, the fact that most general physicians have never had contact with patients suffering from this entity.

Vascular hemichorea: case report and review.

Chorea rarely complicates ischemic or hemorrhagic cerebral vascular lesions. Clinical symptoms usually involve one side of the body while the injury is situated on the contralateral cerebral hemisphere. Spontaneous remission is the norm, but sometimes symptomatic treatment is required. A 58-year-old male patient who suffers from untreated high blood pressure, type II obesity, smokes 6 packs of cigarettes per year and has a moderate intake of alcohol is presented. The patient’'s recent history began three days before he appeared at the Emergency Department. His symptoms were ceaseless, involuntary movements in his left arm and foot during day and night with no restriction of voluntary movements. Physical examination and laboratory tests revealed no other findings. Magnetic resonance imaging of the brain showed hyperintensity in the right posterolateral thalamic region consistent with ischemic cerebrovascular disease. Symptomatic therapy was indicated and his underlying conditions were addressed. The importance of this case lies on the low prevalence as well as the scarcity of publications regarding vascular causes of hemichorea, including diagnosis, therapy and prognosis.

La corea es una rara complicación de las lesiones vasculares cerebrales isquémicas o hemorrágicas y aunque las manifestaciones clínicas son variables, habitualmente se afecta un único hemicuerpo, en cuyos casos la lesión se encuentra en el hemisferio cerebral contralateral. A pesar de que la remisión espontánea es la norma, el tratamiento sintomático en ocasiones es requerido. El caso es un paciente masculino de 58 años de edad, con hipertensión arterial sin tratamiento, obesidad tipo II, consumo de 6 cajetillas de cigarrillos al año e ingesta moderada de alcohol. El paciente inició enfermedad actual tres días previos a acudir al servicio de emergencias, cuando presentó movimientos involuntarios incesantes en miembro superior izquierdo y pie ipsilateral, persistiendo durante el día y observables durante la noche, sin limitación del movimiento voluntario. El examen físico no presentó alteraciones adicionales a los movimientos coreiformes; exámenes pertinentes de laboratorio no alterados. Se realizó resonancia magnética de cerebro revelando hiperintensidad en región talámica posterolateral derecha consistente con enfermedad cerebrovascular isquémica. Se indicó tratamiento sintomático y para patologías de base. El caso es importante por la baja prevalencia y escasos estudios publicados actualizados inherentes al origen vascular de la hemicorea para diagnóstico, pronóstico y tratamiento.

Hemicorea vascular: caso clínico y revisión / Vascular hemichorea: case report and review

La corea es una rara complicación de las lesiones vasculares cerebrales isquémicas o hemorrágicas y aunque las manifestaciones clínicas son variables, habitualmente se afecta un único hemicuerpo, en cuyos casos la lesión se encuentra en el hemisferio cerebral contralateral. A pesar de que la remisión espontánea es la norma, el tratamiento sintomático en ocasiones es requerido. El caso es un paciente masculino de 58 años de edad, con hipertensión arterial sin tratamiento, obesidad tipo II, consumo de 6 cajetillas de cigarrillos al año e ingesta moderada de alcohol. El paciente inició enfermedad actual tres días previos a acudir al servicio de emergencias, cuando presentó movimientos involuntarios incesantes en miembro superior izquierdo y pie ipsilateral, persistiendo durante el día y observables durante la noche, sin limitación del movimiento voluntario. El examen físico no presentó alteraciones adicionales a los movimientos coreiformes; exámenes pertinentes de laboratorio no alterados. Se realizó resonancia magnética de cerebro revelando hiperintensidad en región talámica posterolateral derecha consistente con enfermedad cerebrovascular isquémica. Se indicó tratamiento sintomático y para patologías de base. El caso es importante por la baja prevalencia y escasos estudios publicados actualizados inherentes al origen vascular de la hemicorea para diagnóstico, pronóstico y tratamiento.

Chorea rarely complicates ischemic or hemorrhagic cerebral vascular lesions. Clinical symptoms usually involve one side of the body while the injury is situated on the contralateral cerebral hemisphere. Spontaneous remission is the norm, but sometimes symptomatic treatment is required. A 58-year-old male patient who suffers from untreated high blood pressure, type II obesity, smokes 6 packs of cigarettes per year and has a moderate intake of alcohol is presented. The patient’s recent history began three days before he appeared at the Emergency Department. His symptoms were ceaseless, involuntary movements in his left arm and foot during day and night with no restriction of voluntary movements. Physical examination and laboratory tests revealed no other findings. Magnetic resonance imaging of the brain showed hyperintensity in the right posterolateral thalamic region consistent with ischemic cerebrovascular disease. Symptomatic therapy was indicated and his underlying conditions were addressed. The importance of this case lies on the low prevalence as well as the scarcity of publications regarding vascular causes of hemichorea, including diagnosis, therapy and prognosis.

Hemibalismo invalidante transitorio como debut de diabetes mellitus / Transient hemiballism as the presenting symptom of diabetes mellitus: report of one case

Hemiballism is an uncommon neurological disorder characterized by uncontrollable movements of one lateral half of the body. We report a 56 years old male with a history of three weeks of polydipsia, polyuria and weight loss that, three days before consultation, started with hemiballism. A CAT scan without contrast showed a higher density in the lenticular nucleus and calcifications in caudate and lenticular nuclei. Diabetes was treated with regular insulin and hemiballism was controlled with neruoleptics. Ten days after admission a new CAT scan shows a partial regression of the lenticular lesion. After two months of follow up, the patient is asymptomatic.