Involuntary Choreiform Movements in Hyperglycemia: A Rare Neurological Manifestation of Diabetes

Hemichorea represents a rare but clinically significant hyperkinetic movement disorder in diabetic patients, characterized by abrupt-onset, nonpatterned contractions involving both craniofacial and appendicular musculature. An 82-year-old Asian male who developed progressively worsening choreoathetoid movements with striking left-sided craniofacial predominance, accompanied by ipsilateral limb involvement. Comprehensive neurological assessment showed preserved sensorimotor function despite the dramatic movement disorder. Biochemical profiling revealed markedly elevated serum glucose (28.6 mmol/L) and HbA1c (12.8%). Neuroimaging findings were pathognomonic, with T1-weighted MRI showing unilateral hyperintensity in the right lentiform nucleus, confirming diabetic striatopathy. The patient's clinical presentation was particularly notable for prominent oromandibular dyskinesias and episodic facial grimacing, highlighting the frequently overlooked craniofacial dimension of this condition. Hemichorea-hemiballismus syndrome as a time-sensitive neuroendocrine emergency requires immediate intervention. Movement disorders with craniofacial manifestations should prompt urgent evaluation for metabolic etiologies, as rapid glycemic correction can lead to complete neurological recovery.