Chorea due to nonketotic hyperglycemia.

Area of Science:

• Neurology
• Endocrinology
• Metabolic Disorders

Background:

• Chorea is a hyperkinetic movement disorder characterized by involuntary, irregular, and unpredictable movements.
• Uncontrolled diabetes mellitus is a common metabolic disorder with various neurological complications.
• Hyperglycemia, a hallmark of uncontrolled diabetes, can lead to neuronal dysfunction.

Observation:

• A 62-year-old male with a history of diabetes and hypertension presented with acute onset generalized chorea.
• Initial investigations showed uncontrolled diabetes with normal serum osmolality and absent ketones.
• The patient's involuntary movements resolved completely within 24 hours of achieving euglycemia (normal blood sugar) with insulin therapy.

Findings:

• The study suggests a direct link between hyperglycemia and the development of chorea.
• Striatal neuronal dysfunction, induced by high blood glucose levels, is proposed as the underlying mechanism.
• Rapid correction of hyperglycemia led to the complete resolution of choreiform movements.

Implications:

• This case highlights a potentially reversible cause of chorea in diabetic patients.
• It underscores the importance of glycemic control in preventing or managing neurological manifestations of diabetes.
• Further research may elucidate the precise neurobiological pathways linking hyperglycemia to striatal dysfunction and chorea.