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Hemiballism and chorea with acute/subacute onset: a retrospective series
Yeşim Güzey Aras1, Sena Boncuk Ulaş2, Türkan Acar1
1Department of Neurology, Sakarya University Faculty of Medicine, Sakarya, Turkey.
Insights
Metabolic causes, particularly hyperglycemia, are significant triggers for acute chorea/hemiballismus. This study highlights the prevalence of diabetes mellitus in patients presenting with these hyperkinetic movement disorders.
Area of Science:
- Neurology
- Metabolic Disorders
Background:
- Chorea and ballism are hyperkinetic movement disorders characterized by involuntary movements.
- Distinguishing drug-induced causes from metabolic origins is crucial for acute presentations.
- Hypo-hyperglycemia and electrolyte imbalances are key metabolic etiologies.
Purpose of the Study:
- To present findings from 19 patients diagnosed with acute/subacute onset chorea/hemiballismus.
- To investigate the etiological factors, with a focus on metabolic causes.
Main Methods:
- Evaluated 19 patients with movement disorders.
- Conducted routine biochemistry, HbA1c, hemogram, inflammatory markers, infectious parameters, vitamin levels, and thyroid function tests.
- All patients underwent neuro-imaging.
Main Results:
- The majority of patients (84.2%) were female, with a mean age of 72.21 years.
- A significant proportion (68.42%) had a history of diabetes mellitus, with elevated blood glucose and HbA1c levels observed.
- Common presentations included hemiballismus (68.4%) and choreoathetosis.
Conclusions:
- Chorea/hemiballismus can arise from diverse etiologies.
- Non-ketotic hyperglycemia (NKHHS) is identified as a frequent metabolic cause.
Introduction:
Chorea is a hyperkinetic movement disorder with sudden, irregular, random, dance-like involuntary movements, and ballism is usually one-sided, high-amplitude movements at the proximal of the extremities. In the etiology of acute chorea/hemiballismus, it is necessary to distinguish drugs first and then focus on metabolic causes. The most important etiological causes that may provoke acute/subacute onset chorea/hemiballismus are hypo-hyperglycemia and electrolyte disorders. In this study, we aim to present 19 patients who were admitted to our clinic with movement disorder with acute/subacute onset and diagnosed with chorea/hemiballismus.
Methods:
The study was completed with 19 patients. Routine biochemistry, HbA1c level, hemogram, sedimentation, CRP, hepatitis panels, detailed infective parameters, HIV, vitamin B12 level, folate levels, and thyroid function tests were studied. All patients underwent neuro-imaging.
Results:
16(84.2%) were female and 3(15.8%) were male. The lowest age of the patients was 48 years, the highest age was 89 years, and the mean age was 72.21 years. Thirteen (68.42%) patients had a diagnosis of diabetes mellitus in their history. The blood glucose levels of these patients at the time of admission: the lowest was 99 mg/dl and the highest was 1200 mg/dl. HbA1c values of 11(84.61%) of the 13 patients were also found elevated. Thirteen (68.4%) patients had hemiballismus, 4(21.1%) patients had bilateral choreoathetosis in the four extremities, and 2(10.2%) patients had ballism limited to one upper extremity.
Conclusions:
Chorea/hemiballismus is a movement disorder that is rare and can occur due to a wide range of etiologies. The most common metabolic cause is NKHHS.
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