SHM Converge Scientific Abstract ePoster Gallery-New Movement Disorder in a Young Patient Presenting in HHS

Pdf Summary

This case highlights the neurologic complications that can occur with Hyperosmolar Hyperglycemic State (HHS), including seizures, coma, stroke-like syndromes, and less commonly diabetic striatopathy with hemichorea-hemiballismus syndrome (DS-HBS).<br /><br />A 46-year-old man with poorly controlled type 2 diabetes presented with altered mental status, generalized weakness, dysarthria, and new involuntary movements of the left upper extremity. He also had severe hyperglycemia after months without insulin, along with electrolyte abnormalities and leukocytosis. Because hemichorea and dysarthria can resemble stroke, he underwent neurologic evaluation. EEG was unremarkable, and imaging did not show an acute stroke.<br /><br />The presentation was consistent with diabetic striatopathy, a rare movement disorder associated with non-ketotic hyperglycemia. It typically causes unilateral involuntary movements of the arm, leg, or face and may be diagnosed by the characteristic movement disorder plus imaging changes in the striatum. Since it can mimic stroke, the differential should also include vascular events, seizures, drug effects, and infection.<br /><br />Treatment focuses on correcting the underlying HHS with fluids, insulin, and electrolyte repletion rather than extensive neurologic intervention. In this case, the patient improved with metabolic correction, and the movement disorder resolved before discharge on hospital day 7.<br /><br />The key takeaway is that clinicians should recognize DS-HBS as a reversible cause of new focal involuntary movements in patients with HHS, allowing timely treatment and avoiding unnecessary workup.

Asset Subtitle

Briana Corkill

Meta Tag

Author List Briana Corkill, Eric Tanenbaum

Category Clinical Vignettes

Concept Hyperosmolar Hyperglycemic State

Concept Nonketotic Hyperglycemic Hemichorea/Hemiballismus

Concept Unilateral Movement Disorder

Concept Striatal Imaging Change

Concept Involuntary Movement

Distinguished Non-Finalist

Presenter Organization Swedish First Hill Family Medicine Residency

Presenting Author Briana Corkill

Track Adult

Keywords

Hyperosmolar Hyperglycemic State

HHS

diabetic striatopathy

hemichorea-hemiballismus

non-ketotic hyperglycemia

stroke mimic

altered mental status

dysarthria

seizures

insulin therapy

Hyperosmolar Hyperglycemic State

Nonketotic Hyperglycemic Hemichorea/Hemiballismus

Unilateral Movement Disorder

Striatal Imaging Change

Involuntary Movement