J Neurol Neurosurg Psychiatry 81:1175-1177 doi:10.1136/jnnp.2008.171116
  • PostScript
  • Letter

Activated microglia in the subthalamic nucleus in hyperglycaemic hemiballism: a case report

  1. Hitoshi Yasuda1
  1. 1Division of Neurology, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
  2. 2Division of Nephrology, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
  3. 3Division of Pathology and Disease Regulation, Department of Pathology, Shiga University of Medical Science, Otsu, Shiga, Japan
  1. Correspondence to Dr Kengo Maeda, Department of Neurology, National Hospital Organisation Shiga Hospital, 255 Gochi, Higashi-oumi, Shiga 527-8505, Japan; maeda-kengo{at}
  • Received 22 December 2008
  • Revised 28 July 2009
  • Accepted 25 August 2009
  • Published Online First 14 June 2010

Non-ketotic hyperglycaemia is one of the causes of hemiballism.1 2 The involuntary movement is also sometimes referred to as hemichorea. Hyperglycaemic hemiballism has been thought to occur in patients with pooly controlled diabetes. MRI usually shows a hyperintense lesion of the contralateral basal ganglia in T1-weighted image.3 Although there have been a few pathological studies of hyperglycaemic hemiballism, no studies have shown pathological alteration in the subthalamic nucleus (corpus Luysii) which is responsible for the hemiballism resulting from ischaemia.4 Originally, Schwarz and Barrows reported hyperglycaemic hemiballism as ‘hemiballism without involvement of Luys' body.’2 We herein report a case of hyperglycaemic hemiballism in which immunohistochemistry showed the presence of activated microglia in the subthalamic nucleus contralateral to the hemiballism.

Case report

A 59-year-old man was admitted because of involuntary movement of his right arm that had progressed over 3 days. He had had diabetes mellitus for 19 years treated with insulin injections. Three years prior to admission, he was started on continuous ambulatory peritoneal dialysis (CAPD) due to diabetic nephropathy. One month prior to admission, he began …

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