Open AccessHemichorea Hemiballismus in a Patient with Hyperglycaemic Hyperosmolar State, A Reversible Neurological Outcome of Metabolic Disorder
Author(s) -
AbdSamat AH,
Embong H
Publication year - 2017
Publication title -
hong kong journal of emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.145
H-Index - 12
eISSN - 2309-5407
pISSN - 1024-9079
DOI - 10.1177/102490791702400208
Subject(s) - chorea , medicine , basal ganglia , diabetic ketoacidosis , choreiform movement , movement disorders , propionic acidemia , dystonia , deep brain stimulation , pediatrics , anesthesia , surgery , diabetes mellitus , parkinson's disease , disease , psychiatry , endocrinology , dyskinesia , central nervous system
Hemichorea‐hemiballismus (HCHB) is a spectrum of involuntary, non‐rhythmic movement affecting one side of the body. Although rare, it has been reported as a presenting feature in hyperglycaemic hyperosmolar state (HHS) known in literature as C‐H‐BG (chorea, hyperglycaemia, basal ganglia) syndrome. We present a case in which the patient presented with 2‐day history of right‐sided hemichorea preceded by non‐compliance to oral hypoglycaemic agent. Investigations revealed marked hyperosmolarity and hyperglycaemia, consistent with HHS. Computed tomography (CT) brain showed non‐enhancing hyperdensities at the contralateral putaminal region. The choreiform improved after initiation of treatment for HHS. The hemichorea‐hemiballistic movement can be the presenting feature of HHS, diabetic ketoacidosis or uncontrolled diabetes and is completely reversible with timely management. Nevertheless, CT brain plays diagnostic role and important to rule other more sinister aetiologies. The diagnosis of C‐H‐BG syndrome should be considered in patients with abnormal movement and hyperglycaemia. The symptom can completely recover if the hyperglycaemia is treated accordingly.