Hemichorea presenting as a sign of diabetes mellitus: a case
Hemichorea is a hyperkinetic disorder involving one side of the body, which is caused by lesions of the contralateral striatum. Hyperglycemia is the most common metabolic cause of chorea-ballism. Non-ketotic hyperglycemic (NKH) chorea is more common in elderly patients, especially females.

A 71-year-old female patient presented with involuntary purposeless non-repetitive movements of the left upper and lower extremities involving both the proximal and distal parts, since the last 8 days. These movements were interfering with her daily activities prompting her to come to our hospital. She did not have abnormal behaviour, altered sensorium, weakness of any side, or sensory disturbances.

She was not a known hypertensive or diabetic. No past history of similar illness or stroke was reported. On examination, she was conscious, alert, and oriented. Her pulse rate was 84/min and regular, and her blood pressure was 120/80 mm Hg. The cranial nerve examination was normal. Motor examination revealed normal power; however, hypotonia, hyporeflexia, and intermittent non-repetitive involuntary choreiform movements involving the left upper and lower extremities were noted.

Plantar reflexes were flexor bilaterally. Her sensations were intact. Complete blood count, liver, and renal function tests were normal. Her serum glucose was 416 mg/dl, HbA1c level was 9.2%, and urine ketone bodies were negative. Computed tomography (CT) of the brain revealed hyperdensity in the right caudate nucleus and right lentiform nucleus.

The patient was started on insulin, haloperidol 2 mg/day, and tetrabenazine 50 mg/day. After 5 days, her symptoms improved with marked decrease in involuntary movements. Two weeks later, the abnormal movements disappeared completely and the patient was discharged. The patient refused to have a follow-up CT brain.

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