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Hyperosmolar non-ketotic hyperglycaemia: an important and reversible cause of acute bilateral ballismus

Philip Milburn-McNulty1, Benedict D Michael, Henry J Woodford

  • 1The Walton Centre NHS Trust, Liverpool, UK. philmilburnmcnulty@gmail.com

BMJ Case Reports
|June 26, 2012
PubMed

Insights

A rare case of hyperglycemia-induced chorea-ballism in an elderly woman with type 2 diabetes is presented. Prompt treatment with insulin and tetrabenazine successfully resolved the movement disorder.

Area of Science:

  • Neurology
  • Endocrinology
  • Movement Disorders

Background:

  • Type 2 diabetes mellitus is a common metabolic disorder.
  • Pneumonia is a frequent cause of hospitalization in elderly patients.
  • Hyperglycemia can present with diverse neurological complications.

Observation:

  • An 83-year-old female with type 2 diabetes developed acute onset ballism-choreiform movements after pneumonia treatment.
  • Elevated serum glucose and osmolality were noted.
  • Brain imaging revealed bilateral putamen hyperintensities.

Findings:

  • The patient's symptoms were attributed to hyperglycemia-induced movement disorder.
  • Treatment with subcutaneous insulin normalized glucose levels.
  • Tetrabenazine was initiated for symptom management.

Implications:

  • This case highlights a potential neurological complication of severe hyperglycemia.
  • Early recognition and management of hyperglycemia are crucial.
  • Pharmacological intervention can effectively treat hyperglycemia-induced chorea-ballism.

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