P-MD007. Hemichorea-hemiballismus with non-ketotic hyperglycemia: A movement disorder related to diabetes mellitus

Introduction. Hemichorea-hemiballismus (HCHB) is characterized by unilateral, brief, unpredictable involuntary movements of one body side. Methods. Three patients with HCHB complaints with hyperglycemia in the early symptoms of acute ischemic stroke were collected. Results. Three cases of sudden-onset hemichorea-hemiballismus movements of the upper and lower extremities were reported. First: Male, 63, uncontrolled movements in his right arm and leg worsened over time with a history of type 2 diabetes mellitus, uncontrolled for 10 years with the same history of DM in his family. The serum glucose level was 450 mg/dL, with 10.8% HbA1c, 3+ urine glucose and negative urine ketone. CT brain showed infarction of left basal ganglia. Second: Male, 51, involuntary movements in his left arm and leg for 13 days before admitted to the hospital. Serum glucose levels at the beginning of the disorder were 455 mg/dL with negative urine ketone. Head MRI showed hyperacute infarction in the right basal ganglia and right caudate nucleus. Third: Male, 44, with past history of uncontrolled DM, coming with involuntary movements in his right arm and leg occurring suddenly 4 h while driving a car. The serum glucose level at the beginning of the disorder was 264 mg/dl and negative urine. Head CT scan showed infarction of the left basal ganglia. Conclusion. The combination of new striatal lesions and hyperglycemia is related to the appearance of unilateral hyperkinetic movement disorders in patients. When hyperglycemia is detected and managed, movement disorders disappear within a few days and may not require symptomatic therapy with dopamine receptor antagonists.