SHM Converge Scientific Abstract ePoster Gallery-Diabetic Hemiballism: A Reversible Cause of Chorea

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This case describes a 58-year-old woman with hypertension, hypothyroidism, and type 2 diabetes who presented with two days of involuntary movements of her right upper extremity. Her workup showed extreme hyperglycemia (glucose 1273 mg/dL), mild anion gap elevation, acute kidney injury, and no ketosis, consistent with hyperosmolar hyperglycemic state (HHS). Infectious and vascular evaluations were negative. Her HbA1c later returned at 16%, indicating very poor long-term glycemic control.<br /><br />The patient was treated in the ICU for HHS. Her choreiform/ballistic movements resolved within 24 hours after blood glucose correction, so MRI was not pursued. The movements were attributed to diabetic hemiballism, also known as diabetic striatopathy or nonketotic hyperglycemia chorea-ballismus.<br /><br />The discussion explains that diabetic hemiballism is a rare metabolic syndrome defined by the triad of unilateral hemichorea/hemiballismus, severe nonketotic hyperglycemia, and characteristic striatal abnormalities on neuroimaging. It most often affects adults aged 50–80 years and is more common in women. Symptoms are typically acute, irregular, nonrhythmic involuntary movements that occur while awake and disappear during sleep. MRI usually shows unilateral hyperintensity in the basal ganglia, especially the putamen.<br /><br />Although the disorder is uncommon, it is important to recognize because prognosis is generally favorable. Rapid and aggressive glucose control often leads to improvement within 24–48 hours, with imaging abnormalities resolving over months.<br /><br />Key takeaway: in patients with acute unilateral chorea or hemiballismus, especially with severe hyperglycemia, diabetic hemiballism should be considered because prompt treatment can lead to complete recovery.

Asset Subtitle

Bridget B. Hottenstein

Meta Tag

Author List Bridget B. Hottenstein, Vijairam Selvaraj

Category Clinical Vignettes

Concept Diabetic Hemiballism

Concept Hyperglycemia

Concept Hemichorea

Concept Hemiballismus

Concept Striatum

Distinguished Non-Finalist

Presenter Organization Warren Alpert School of Medicine, Brown University Health

Presenting Author Bridget B. Hottenstein

Track Adult

Keywords

diabetic hemiballism

hyperosmolar hyperglycemic state

nonketotic hyperglycemia

hemichorea

hemiballismus

striatal abnormalities

basal ganglia

severe hyperglycemia

type 2 diabetes

glucose control

Diabetic Hemiballism

Hyperglycemia

Hemichorea

Hemiballismus

Striatum