[A rare neurologic syndrome due to a common medical condition]

Area of Science:

• Neurology
• Endocrinology
• Geriatrics

Background:

• Chorea is an uncommon neurological disorder in the elderly, often associated with various underlying conditions.
• This case highlights a patient with multiple comorbidities including hypertension, diabetes mellitus, and renal failure, presenting with recurrent chorea.

Observation:

• A thorough diagnostic work-up failed to identify common causes of chorea in this elderly patient.
• The patient exhibited significantly elevated HbA1c levels (>17%) and brain CT scans revealed characteristic dense lesions in the basal ganglia.

Findings:

• The patient was diagnosed with Chorea Hyperglycemia Basal Ganglia syndrome, characterized by chorea, hyperglycemia, and basal ganglia lesions.
• Hemichorea, a type of chorea, was directly linked to non-ketotic hyperglycemia and demonstrated improvement with insulin therapy.

Implications:

• This case underscores the importance of considering Chorea Hyperglycemia Basal Ganglia syndrome in elderly patients with unexplained chorea and uncontrolled diabetes.
• Effective management of hyperglycemia through insulin treatment is crucial for clinical and radiological improvement in this syndrome.