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Choreoathetosis associated with non-chetotic hyperglycemia
Roberto Valenti1, Elena Ceccarelli, Alfonso Cerase
1Department of Internal Medicine and Metabolic Disease, University of Siena, Siena, Italy. valenti6@unisi.it
Acta Diabetologica
|July 9, 2010
Summary
Chorea-acanthocytosis, a rare neurological complication of diabetes, can manifest as involuntary movements. Effective glycemic control through diet and insulin therapy can reverse these symptoms in type 2 diabetes mellitus patients.
Area of Science:
- Neurology
- Endocrinology
- Radiology
Background:
- Choreoathetosis is a rare neurological complication associated with diabetes mellitus.
- Poorly controlled type 2 diabetes mellitus (DM type 2) can lead to various systemic complications, including neurological deficits.
Observation:
- An elderly woman with a 6-year history of poorly controlled type 2 diabetes mellitus presented with a 20-day history of choreic movements on the left side of her body.
- Brain imaging revealed abnormalities in the right putamen, including high signal intensity on T1-weighted, T2-weighted, diffusion-weighted images, and apparent diffusion coefficient maps.
- Computed tomography of the brain was unremarkable.
Findings:
- Treatment with diet therapy and adjusted insulin regimen (regular insulin with meals and basal glargine at bedtime) led to normalized blood glucose levels and improvement in choreic movements.
- Magnetic resonance imaging findings suggest a correlation between non-ketotic hyperglycemia and neurological lesions causing choreoathetosis in the basal ganglia.
- The etiopathogenesis appears multifactorial, involving hyperosmolar damage, altered GABA neurotransmission, and impaired cerebral vascular autoregulation.
Implications:
- This case highlights that choreoathetosis in the context of DM type 2, while rare, is a potentially reversible complication.
- Adequate glycemic control is crucial for managing and potentially resolving this neurological manifestation.
- The findings underscore the importance of considering neuro-metabolic and vascular alterations in the basal ganglia due to chronic hyperglycemia.
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