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Persistent chorea triggered by hyperglycemic crisis in diabetics

J E Ahlskog1, H Nishino, V G Evidente

  • 1Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA.

Movement Disorders : Official Journal of the Movement Disorder Society
|December 18, 2001
PubMed

Insights

Severe hyperglycemia can cause persistent chorea (involuntary movements) in women, even after blood sugar levels normalize. This movement disorder may require long-term neuroleptic treatment.

Area of Science:

  • Neurology
  • Endocrinology
  • Movement Disorders

Background:

  • Hyperglycemia, particularly severe episodes (500-1,000 mg/dL), is a known but poorly understood cause of neurological dysfunction.
  • Chorea, a hyperkinetic movement disorder, has been anecdotally linked to hyperglycemic crises, often in older individuals with established diabetes.

Observation:

  • Five female patients presented with new-onset chorea coinciding with or following severe hyperglycemic episodes.
  • Four patients had no prior history of diabetes mellitus, suggesting hyperglycemia as the primary trigger.
  • The chorea was subacute, varied in presentation (generalized, unilateral), and persisted long-term (6 months to 5 years) despite glucose normalization.

Findings:

  • Unlike previously reported cases, the chorea in these patients was largely irreversible.
  • Magnetic resonance imaging (MRI) revealed basal ganglia abnormalities (T1 hyperintensity) in four patients, but not in the most clinically affected individual.
  • No other predisposing factors besides hyperglycemia were identified, highlighting its critical role.

Implications:

  • This study suggests a subset of patients may develop persistent, treatment-refractory chorea following severe hyperglycemia.
  • The findings challenge the notion of chorea exclusively as a reversible complication of hyperglycemia.
  • Further research into the pathophysiology of hyperglycemia-induced persistent chorea is warranted to guide therapeutic strategies.

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