Hemichorea-Hemiballism Syndrome in a Patient With Diabetic Striatopathy and Lacunar Stroke

Hemichorea-hemiballism syndrome is a hyperkinetic movement disorder that is usually associated with stroke within the basal ganglia, thalamus, or subthalamic area. However, it can also occur as a rare manifestation of severe hyperglycemia. The simultaneous or subsequent occurrence of ischemic stroke and diabetic striatopathy has only been reported in a few cases. We present a rare case of acute onset of involuntary movements in the right upper and lower extremities, which was initially thought to be associated solely with hyperglycemia. A non-contrast computed tomography (NCCT) scan of the brain revealed a hyperdense left caudate nucleus and lentiform nucleus. The patient was treated with antidiabetic medications. However, due to the persistence of neurological symptoms, a follow-up CT was performed, which showed evidence of a lacunar stroke in the left caudate nucleus. Treatment with aspirin and haloperidol was administered. On further follow-up, the patient's clinical condition has fully recovered. This case report highlights the potential presence of two independent conditions that can manifest as an identical neurological condition. Prompt and accurate identification of those conditions is crucial for avoiding misdiagnosis and delays in treatment.