Objective: To present a rare case of hemichorea as a neurological manifestation of hypoglycemia, highlighting the importance of considering metabolic factors in patients with movement disorders.

Background: ​​​​Hemichorea commonly presents as involuntary, unilateral, dance-like movements and is associated with various factors, including metabolic disorders. Studies suggest that Asians have a predisposition to chorea-ballismus (71.6%), with a female predominance and an average onset age of 67.6 years. Diabetic striatopathy was identified as the second leading cause overall and the primary etiology within the metabolic case group (accounting for 1% of total cases), followed by electrolyte imbalances and thyroid disorders. Hemichorea as a manifestation of hypoglycemia is exceedingly rare and poorly documented in clinical literature.

Method: A case report presenting a 67-year-old female with hyopglycemia-induced hemichorea.

Results: A 67-year-old lethargic female with a history of poorly controlled diabetes mellitus presented with worsening choreiform movements of the right upper and lower extremities over three days before admission. These hyperkinetic movements were short, arrhythmic, involuntary, and did not resolve with sleep. Upon examination, the patient was conscious without any neurological deficit. Laboratorium tests revealed a low blood glucose level of 31 mg/dL, which was attributed to insufficient intake combined with daily insulin use.

The patient had a history of very subtle and very mild hemichorea one month prior, due to non-ketotic hyperglycemia (blood sugar levels were recorded as high as 729 mg/dL). After treatment, these mild movements persisted, but were neglected due to their lack of severity.

Brain MRI with contrast revealed hyperintensity of the lentiform nucleus on T1-weighted imaging, with increased susceptibility of the basal ganglia bilaterally, indicative of a metabolic lesion. Any evidence of space-occupying lesions, hemorrhages and infarcts was absent. The patient’s symptoms consequently improved after blood sugar correction, combined with symptomatic treatments of oral haloperidol and clonazepam.

Conclusion: Hypoglycemia is a rare but potentially important cause of hemichorea, emphasizing the need to recognize metabolic factors in its diagnosis and management

References: 1. Zheng W, Chen L, Chen JH, et al. Hemichorea Associated With Non-ketotic Hyperglycemia: A Case Report and Literature Review. Front Neurol. 2020;11:96. Published 2020 Feb 25. doi:10.3389/fneur.2020.00096
2. Rupp J, Gillespie A. A Case of Diabetic Hemichorea Hemiballismus Exacerbated by Hypoglycemia. AACE Clin Case Rep. 2021;7(5):327-329. Published 2021 Apr 24. doi:10.1016/j.aace.2021.04.004
3. Zheng J, Sliem A, Magana S, Kapoor A. Hypoglycemia as a Cause of Reversible Recurrent Chorea in a Diabetic Uremic Patient: A Rare Presentation. Cureus. 2023;15(5):e39292. Published 2023 May 21. doi:10.7759/cureus.39292
4. Costa Hoffmeister M, Bonavides PSG, Maurer Wiercinski V, et al. Hyperglycemia-induced hemichorea-hemiballismus syndrome – a systematic review. Arch Endocrinol Metab. 2024;68:e220413. doi:10.20945/2359-4292-2022-0413
5. Pasini F, Karantzoulis A, Fanella G, et al. Hypoglycemic Encephalopathy Manifesting with Cortical Hemichorea-Hemiballismus Syndrome: A Case Report. Case Rep Neurol. 2023;15(1):24-30. Published 2023 Feb 7. doi:10.1159/000528880
6. Matsushima E, Shiota H, Watanabe K, et al. Hemichorea after hypoglycemic episodes with negative MRI findings in an elderly woman with poorly controlled type 2 diabetes mellitus: a case report. BMC Neurol. 2019;19(1):131. Published 2019 Jun 15. doi:10.1186/s12883-019-1334-2
7. Wang R, Li M, Wang Y, Tang CZ, Wang YC. Effect of Infection on the Incidence of Hyperglycemic Hemichorea: A Case-Series. Diabetes Metab Syndr Obes. 2024;17:3455-3462. Published 2024 Sep 16. doi:10.2147/DMSO.S470482
8. Dong M, E JY, Zhang L, Teng W, Tian L. Non-ketotic Hyperglycemia Chorea-Ballismus and Intracerebral Hemorrhage: A Case Report and Literature Review. Front Neurosci. 2021;15:690761. Published 2021 Jun 23. doi:10.3389/fnins.2021.690761
9. Arecco A, Ottaviani S, Boschetti M, Renzetti P, Marinelli L. Diabetic striatopathy: an updated overview of current knowledge and future perspectives. J Endocrinol Invest. 2024;47(1):1-15. doi:10.1007/s40618-023-02166-5

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MDS Abstracts - https://www.mdsabstracts.org/abstract/hemichorea-as-an-atypical-manifestation-of-hypoglycemia-a-rare-case-report/