Hemichorea associated with non-ketotic hyperglycemia: a case report and literature review

Hemichorea associated with non-ketotic hyperglycemia (HC-NH) is a rare neurological complication and is also considered a specific complication of diabetes. Its exact pathogenesis remains unclear. We report a case of a 79-year-old female patient with HC-NH. Her primary clinical presentation included involuntary movements in the right limbs that began 3 days prior to admission. These movements worsened during emotional agitation and could be accompanied by insomnia but resolved after falling asleep. Imaging studies revealed no significant intracranial lesions on CT. MRI showed hyperintensity on T1-weighted images (T1WI) in the left globus pallidus and putamen and slightly lower signal intensity on T2-weighted imaging (T2WI). Fingerstick glucose monitoring during hospitalization showed only mild elevation, and urine ketones showed negative results. Treatment included glucose control, tiapride, Trihexyphenidyl, and haloperidol for choreiform movements, along with lorazepam to alleviate anxiety and tension. The patient showed slight improvement, and choreiform movements markedly diminished 3 months after discharge. This case demonstrates that blood glucose levels may not be markedly elevated at the onset of HC-NH, potentially leading to delayed or misdiagnosis. Additionally, symptom control may not achieve optimal results in the short term. Therefore, early diagnosis and treatment are crucial for the prognosis of this condition.