Hemichorea - hemiballismus in undiagnosed diabetes mellitus asian female patient associated with non ketotic hyperglycemia: putamenal and caudate nucleus lesions on magnetic resonance imaging

Rajkumar Prakashbhai Doshi, Viralkumar Patel, Keyur Patel, Maulik Patel


Hemichorea-Hemiballismus (HCHB) with corresponding putaminal T1 hyperintensity on MRI has occasionally been reported in diabetes mellitus (DM) type 2 with non ketotic hyperglycemia, which is believed to be pathogenetically related to HCHB. A 65 year female presented with fever, diarrhea, and involuntary movements on all 4 limbs in known case of diabetes mellitus type 2, hypertension, chronic heart failure and chronic renal failure. We report occurrence of HCHB in a female patient with DM type 2, Hypertension and acute renal failure.


Hemichorea-Hemiballismus, Hyperglycemia, MRI

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Qi X, Yan Y, Gao Y, Zheng Z, Chang Y: Hemichorea associated with non-ke- totic hyperglycaemia: a case report. Diabetes Res Clin Pract. 2012;95(1):e1–e3.

Slabu H, Savedia-Cayabyab S, Senior P, Arnason T: Permanent haemicho- rea associated with transient hyperglycemia. BMJ Case Rep. 2011. pii: bcr0820114641.

Dewey RB Jr, Jankovic J. Hemiballis nm m‐hemichorea. Clinical and pharmacologic findings in 21 patients. Arch Neurol. 1989;46:862‐7.

Lee S, Shin J, Kim J. “Chorea-ballism associated with nonketotic hyperglycaemia or diabetic ketoacidosis: character- istics of 25 patients in Korea,” Diabetes Research and Clinical Practice. 2011;93,(2).e80–e83.

Nagai, C, Kato T, Katagiri T, Sasaki H. Hyperintense putamen on T1-weighted MR images in a case of chorea with hyperglycemia. American Journal of Neuroradiology. 1995;16:1243-6.

Chang MH, Chiang HT, Lai PH. Pu- taminal petechial haemorrhage as the cause of chorea: A neuroimaging study. Journal of Neurology, Neurosurgery, and Psychiatry. 1997;63:300-3. doi:10.1136/jnnp.63.3.300.

Cherian, A, Thomas B, Baheti NN, Chemmanam T. Kesavadas C. Concepts and controversies in nonketotic hyperglycemia-induced hemichorea: Fur- ther evidence from susceptibility-weighted MR imaging. Journal of Magnetic Resonance Imaging. 2009;29,699-703. doi:10.1002/jmri.21672

Chu K, Kang DW, Kim DE, Park SH. Roh JK. Diffusion-weighted and gradient echo mag- netic resonance findings of hemichorea-hemiballismus associated with diabetic hyperglycemia: A hyperviscosity syndrome? Archives of Neurology. 2002;59:448-452. doi:10.1001/archneur.59.3.448

Song C, Yang X, Xing G. Hemichorea associated with nonketotic hyperglycemia in a female, Neuro Endocrinology Letter. 2012;33,(5):489-92.

Mestre TA, Ferreira JJ, Pimentel J. Putaminal petechial haemorrhage as the cause of non‐ketotic hyperglycaemic chorea: A neuropathological case correlated with MRI findings. J Neurol Neurosurg Psychiatry. 2007;78:549‐50.

Chu K, Kang DW, Kim DE, Park SH, Roh JK. Diffusion‐ weighted and gradient echo magnetic resonance findings of hemichorea‐hemiballismus associated with diabetic hyperglycemia: A hyperviscosity syndrome? Arch Neurol. 2002;59:448‐52.

Wintermark M, Fischbein NJ, Mukherjee P, Yuh EL, Dillon WP. Unilateral putaminal CT, MR, and diffusion abnor- malities secondary to nonketotic hyperglycemia in the setting of acute neurologic symptoms mimicking stroke, American Journal of Neuroradiology. 2004;25,(6):975-6.

Chang CV, Felicio AC, Godeiro C et al. Chorea-ballism as a manifestation of decompensated type 2 diabetes mellitus, American Journal of the Medical Sciences. 2007;333,(3):175-177.

Branca D, Gervasio O, Le Piane E, Russo C,

Aguglia U. Chorea induced by non-ketotic hyperglycaemia: a case report, Neurological Sciences. 2005;26,(4):275-7.

Hwang KJ, Hong IK, Ahn TB. Cortical hemichorea-hemiballism. J Neurol, 2013;260(12):2986–92.

Lin JJ, Chang MK: Hemiballism-hemichorea and non-ketotic hyperglycemia. J Neurol Neurosurg Psychiatry. 1994;57(6):748-50.