Wednesday, 3 August 2016

Nonketotic Diabetic Hemichorea-Hemiballismus in the Emergency Department

                                                   www.mathewsopenaccess.com


We present a case of a 59-year old diabetic Jamaican male who presented to the emergency department with hemichorea-hemiballismus (HC-HB). HC-HB is a rare presentation of nonketotic hyperglycemia. While previously described in radiology, neurology and endocrinology literature, reports of this hyperkinetic movement caused by hyperglycemia are rare in the emergency medicine literature. Various conditions may cause hemichorea-hemiballismus. We highlight a case that illustrates the important distinguishing features of nonketotic hyperglycemic hemichorea-hemiballismus diagnosed in the emergency department.

Hemichorea-hemiballismus (HC-HB) is a rare presentation of nonketotic hyperglycemia. Chorea is characterized by involuntary, poorly patterned, short lasting jerky movements. Ballismus, on the other hand, is described as large amplitude flailing movements. While previously described in journals of radiology, neurology and endocrinology literature, reports of this hyperkinetic movement caused by hyperglycemia are rare in the emergency medicine literature. While various conditions may cause hemichorea-hemiballismus, we present a case that illustrates the important distinguishing features of nonketotic hyperglycemic hemichorea-hemiballismus.


A 59-year-old Jamaican male presented to the emergency department (ED) with complaints of involuntary movements of his left upper and left lower extremities that started one day prior to arrival. The patient’s family also reported an episode of transient slurred speech at the onset of the patient’s symptoms which resolved prior to arrival to the ED. The patient denied any other neurological complaints. The patient had no history of seizures and denied any history of drug or alcohol use. He had no recent travel, trauma, illness or hospitalization. His only medical history was diabetes.

He admitted that he had not taken his prescribed metformin and glyburide for several weeks. He did not have health insurance coverage and stated that he had not been able to afford his medications and glucose test strips. The patient’s physical exam showed a very lean man in no acute distress. There were no cranial nerve deficits and no facial asymmetry. He had no visual field cuts. His extremities were noted to have normal strength and sensation. His gait was steady and no ataxia was observed. He was noted to have irregular, short-lasting, involuntary movements of his left upper and left lower extremities during the exam.

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