Corticosteroid induced hyperosmolar hyperglycaemic state and hemiballismus

Area of Science:

• Neurology
• Endocrinology
• Pharmacology

Background:

• Corticosteroids, like prednisolone, are commonly used to manage inflammatory conditions such as polymyalgia rheumatica.
• Hyperglycemia, or high blood sugar, can have various neurological manifestations.
• Hemiballismus is a rare hyperkinetic movement disorder characterized by involuntary, violent, and random-seeming movements.

Observation:

• An 89-year-old male presented with new-onset left-sided hemiballismus affecting his face, arm, and leg.
• The patient had recently commenced prednisolone treatment for polymyalgia rheumatica and presented with significant hyperglycemia (glucose 20.2 mmol/l).

Findings:

• Brain imaging revealed a hypointense lesion in the right lentiform nucleus on T2-weighted MRI, a common finding in stroke or metabolic disturbances.
• The patient's hemiballismus symptoms showed marked improvement following the management of his hyperglycemia and diabetes mellitus.

Implications:

• This case suggests a potential, previously unreported, association between corticosteroid use and the development of hemiballismus, possibly mediated by hyperglycemia.
• Highlights the importance of considering metabolic disturbances, particularly hyperglycemia, in the differential diagnosis of new-onset movement disorders in patients on corticosteroids.
• Further research is warranted to explore the potential neurotoxic effects of corticosteroids or steroid-induced hyperglycemia on basal ganglia function.