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Hemorrhagic Stroke l: Introduction01:17

Hemorrhagic Stroke l: Introduction

A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...
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Haemorrhagic stroke or hyperglycaemia?

Leena Jalota1, Sarah Luber, Rijesh Shrestha

  • 1Department of Internal Medicine, Reading Health System, West Reading, Pennsylvania, PA, USA. leena.jalota@gmail.com

BMJ Case Reports
|July 25, 2013
PubMed
Summary

Uncontrolled diabetes can cause hemiballistic-choreiform movements. Prompt insulin therapy in a patient with hyperglycemia resolved these neurological symptoms, highlighting the link between blood sugar and movement disorders.

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Area of Science:

  • Neurology
  • Endocrinology
  • Metabolic Disorders

Background:

  • Hyperglycemia and diabetic ketoacidosis can present with diverse neurological manifestations.
  • Movement disorders are an uncommon but recognized complication of poorly controlled diabetes mellitus.

Observation:

  • A 56-year-old woman presented with acute hemiballistic-choreiform movements of the right extremity.
  • Initial investigations revealed severe hyperglycemia (HbA1c 17.9%, average blood sugar 467 mg/dL) and basal ganglia hyperintensities on CT.
  • Symptoms resolved within 48 hours of initiating subcutaneous insulin therapy.

Findings:

  • Recurrence of milder symptoms was noted with elevated HbA1c (13.9%) and blood sugar (352 mg/dL).
  • MRI confirmed persistent basal ganglia signal abnormalities without evidence of infarct.
  • While insulin improved symptoms, resolution required additional medications like haloperidol and gabapentin.

Implications:

  • This case underscores the potential for severe hyperglycemia to induce reversible movement disorders.
  • Early recognition and management of hyperglycemia are crucial in patients presenting with unexplained chorea or hemiballismus.
  • Further research into the pathophysiology of hyperglycemia-induced movement disorders is warranted.