E-Pearl of the Week: Sweet Dancing: Hemichorea-hemiballismus in nonketotic hyperglycemia

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September 22, 2014

Nonketotic hyperglycemia (NKH) is an unusual cause of hemichorea-hemiballismus syndrome. It is more common among elderly women. [1] NKH induced chorea is typically associated with unilateral or bilateral lesions of the putamen or caudate nucleus on CT and/or T1-weighted MRI images; reminiscent of a basal ganglia hemorrhage. [1] Despite the characteristic clinical and imaging findings, the underlying mechanism is still unclear. This entity has a good prognostic outcome if the hyperglycemia is recognized early and corrected. Hemichorea-hemiballismus has also been reported in the setting of diabetic ketoacidosis. [2]  


  1. Oh SH, Lee KY, Im JH, Lee MS. Chorea associated with non-ketotic hyperglycemia and hyperintensity basal ganglia lesion on T1-weighted brain MRI study: a meta-analysis of 53 cases including four present cases. J Neurol Sci. 2002; 200: 57-62. 
  2. Duker AP, Espay AJ. Images in clinical medicine. Hemichorea–hemiballism after diabetic ketoacidosis. N Engl J Med. 2010; 363: e27.   

Submitted by Anteneh M. Feyissa, MD, MSc. Chief Resident, Department of Neurology, University of Texas Medical Branch at Galveston, Texas.  

Disclosures: Dr. Feyissa reports no disclosures.

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