Abstract Details

Title Hemichorea as the Presenting Symptom of Severe Hyperglycemia

Topic General Neurology

Presentation(s) P1 - Poster Session 1 (12:00 PM-1:00 PM)

Poster/Presentation
Number 6-010

Objective NA

Background Nonketotic hyperglycemic hemichorea also known as chorea hyperglycemia basal ganglia syndrome (C-H-B-G) is a disorders that presents with hemichorea/hemiballismus in the setting of severe hyperglycemia, which is associated with T1 hyperintensities in the basal ganglia. In the majority of the case reports and case series that describe this phenomena the demographic that is affected are older women with a mean age of 67-71, typically of Asian descent. The resolution of the hemichorea usually requires weeks to months of treatment with antihyperglycemic medications. The use of neuroleptics such as Haloperidol, or benzodiazepines in these cases have also been used to treat hemichorea. The objective of this case report is to highlight the young age of the patient that experienced this phenomena, and discuss the rapid resolution of her symptoms.

Design/Methods We present a case of a 28 year old African American female with type two diabetes, diagnosed at the age of 14, who arrived to the hospital after one brief episode of left hand hemichorea in the setting of hyperosmolar hyperglycemia. Her presenting blood glucose level was 512 and her hemaglobin A1c was 14.4. This episode resolved without intervention (the use of antihyperglycemic medications or neuroleptics) prior to her arrival to the hospital.

Results NA

Conclusions This phenomena that causes the patient to experience hemichorea, and appear as T1 hyperintensities in the basal ganglia, is thought to be related to years of chronic focal vascular injury, petechial hemorrhages, and aberrations of the blood brain barrier in the basal ganglia secondary to increased metabolism in this region. This was believed to be the reason the average age of patients being affected is between 67 and 71. However, there may be an increase in similar presentations among juveniles and young adults in the future due to the increased rate of uncontrolled diabetes in this population.

Authors/Disclosures
Rena Sukhdeo Singh, MD PRESENTER	No disclosure on file
Hafiz Elahi, MD	No disclosure on file
Aman Deep, MD	Dr. Deep has nothing to disclose.
Andrew Schroeder, MD (UTHSC)	No disclosure on file
Hafiz Elahi, MD	No disclosure on file