Vascular Dementia and Movement Disorders

Biography

Biography: Tisha Gay C. Tancongco

Abstract

Non-ketotic hyperglycemia among type II diabetic patients has been documented to cause a rare movement disorder called Hemichorea-hemiballism syndrome. This is a hyperkinetic movement disorder presenting as a continuous, non-patterned, involuntary movements caused by a basal ganglia dysfunction. The movement disorder has an overall incidence of 1 in 500,000 of the general population, while the incidence directly caused by non-ketotic hyperglycemia is yet to be determined.

This case is a 76-year old male who presented with involuntary movements of the right extremities. The increasing intensity of the involuntary movements over 10 days prompted consult to a physician. On admission, the patient was conscious with stable vital signs. Involuntary movements of the right upper and lower extremities were observed. The patient had uncontrolled diabetes with an HBA1c of 12.6%, FBS of 128mg/dl and negative for urinary ketones. The Brain MRI with contrast demonstrated T1 hyperintensity signals involving the left caudate and left lentiform nucleus. The T2/FLAIR weighted imaging showed mixed hyperintense and hypointense signals on the left basal ganglia consistent with abnormal MRI findings in diabetic patients with non-ketotic hyperglycemia. The patient was then treated for diabetes and was maintained on risperidone and clonazepam for the involuntary movements. After 5 months, the patient’s diabetes were controlled, and the involuntary movements has completely resolved.

The case highlights non-ketotic hyperglycemia in a diabetic patient presenting as Hemiballismus-Hemichorea syndrome. The prompt recognition and correction of hyperglycemia leads to a rapid improvement of symptoms, less neurologic sequelae and an overall favorable prognosis.