SHM Converge Scientific Abstract ePoster Gallery-A Rare Case of Non-Ketotic Hyperglycemic Hemichorea

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This case describes a 69-year-old woman with type 2 diabetes and hypertension who presented with shortness of breath, cough, fever, facial and hand swelling, and was found to have acute renal failure, pulmonary edema, and pleural effusions requiring hemodialysis, diuretics, and thoracentesis. During hospitalization, she was noted to have mild involuntary spasms and jerking movements, predominantly in the right lower extremity with some involvement of the right upper extremity, causing poor coordination, ataxia, and disbalance. Her daughter reported these abnormal movements had been occurring intermittently for about 1.5 months.<br /><br />Brain MRI showed asymmetric T1 hyperintensity in the left basal ganglia and caudate nucleus, and labs revealed poorly controlled diabetes with an HbA1c of 9.9 and glucose levels ranging from the 150s to 300s. Based on the clinical presentation and imaging, she was diagnosed with nonketotic hyperglycemic hemichorea (NHC), a rare but potentially reversible neurologic complication of uncontrolled diabetes. MRI also showed small acute infarcts in the left temporal and frontal periventricular white matter, likely related to hypertension, but these did not explain her movement disorder.<br /><br />She was started on a VMAT2 inhibitor and discharged with outpatient neurology follow-up. The report emphasizes that NHC typically presents as acute or subacute hemichorea-hemiballismus with severe hyperglycemia without ketosis, often in older women. While characteristic MRI findings may support the diagnosis, they are not required. Prompt recognition and strict glycemic control are essential for recovery.

Asset Subtitle

Kanza Maqsood

Meta Tag

Author List Anjum Dhamani, Anunaya Aashish, Carolina De La Porte, Kamran Chaudhry, Kanza Maqsood, Kendra Calvin, Sarah Misbah, Tanmayee Polamraju

Category Clinical Vignettes

Concept Nonketotic Hyperglycemic Hemichorea/Hemiballismus

Concept Diabetes Mellitus

Concept Chorea

Concept Ballismus

Concept Hyperglycemia

Distinguished Non-Finalist

Presenter Organization Texas Health Resources HEB/Denton Internal Medicine Residency

Presenting Author Kanza Maqsood

Track Adult

Keywords

nonketotic hyperglycemic hemichorea

uncontrolled diabetes

hemichorea-hemiballismus

basal ganglia MRI

T1 hyperintensity

hyperglycemia

type 2 diabetes

VMAT2 inhibitor

neurologic complication

glycemic control

Nonketotic Hyperglycemic Hemichorea/Hemiballismus

Diabetes Mellitus

Chorea

Ballismus

Hyperglycemia