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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
Summary
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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