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RECURRENT HEMICHOREA AS A MARKER OF GLYCAEMIC CONTROL
  1. A Drazyk,
  2. L Williams,
  3. R Killeen,
  4. J Kinsella,
  5. C McGuigan
  1. Department of Neurology and Neuroradiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland

Abstract

Introduction Chorea describes abnormal involuntary movements of the limbs and can be a manifestation of a variety of conditions associated with dysfunction of the basal ganglia and their connections. Chorea, hyperglycaemia, basal ganglia syndrome is a rare cause of the disorder. 

Case History: 74 year old woman with type 2 diabetes, presented with sudden involuntary movements affecting her right arm and leg.

Investigations revealed nonketotic hyperglycaemia; blood glucose 21 mmol/L and HbA1C, 119 mmoL/L.

MRI scan of brain showed hyperintensities on T1-weighted imaging within the left lentiform nucleus with corresponding low signal on T2-weighted imaging, no infarcts were seen.

The appearances were suggestive of chorea, hyperglycaemia, basal ganglia syndrome.

Symptoms resolved within one week of achieving adequate glycaemic control. Following an eighteen month period of stability the patient represented with recurrence of choreiform movements. Blood glucose was 33,2 mmol/L and HbA1C, 142 mmoL/L.

Clinical improvement once again followed optimisation of glycaemic control, but over a more prolonged period. Repeat imaging showed similar changes.

Conclusion Chorea is a rare complication of hyperglycaemia in diabetic patients.

The exact mechanism for the syndrome is unknown.

Recurrent episodes may aid our understanding of the condition suggesting a possible underlying vascular vulnerability. 

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