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Hyperglycemic chorea: clinical insights and a narrative review of case reports

Amteshwar Singh1, Ram Agrawal1, Waseem Khaliq1

  • 1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Postgraduate Medicine
|June 19, 2026
PubMed

Insights

Hyperglycemic chorea (HC), a rare complication of uncontrolled diabetes, causes involuntary movements. Prompt glycemic control and neuroimaging are crucial for diagnosis and symptom resolution in elderly patients.

Area of Science:

  • Neurology
  • Endocrinology
  • Radiology

Background:

  • Hyperglycemic chorea (HC), or diabetic striatopathy, is an underrecognized complication of poorly controlled diabetes mellitus.
  • It presents as involuntary, often unilateral, choreiform or ballistic movements, with unclear pathophysiology.
  • HC is a significant differential diagnosis for acute-onset chorea in elderly individuals with hyperglycemia.

Purpose of the Study:

  • To characterize the epidemiology, clinical features, imaging findings, treatment, and outcomes of hyperglycemic chorea.
  • To review published case reports and case series on HC.

Main Methods:

  • A narrative review of English-language case reports and case series on HC was conducted using PubMed/MEDLINE.
  • Inclusion criteria comprised adult patients (≥18 years) with chorea attributed to hyperglycemia.
  • Eighty publications involving 100 patients were included, adhering to PRISMA guidelines.

Main Results:

  • The study included 100 patients (mean age 66.6 years, 67% female), with hemichorea being most common (71%, left-sided).
  • Most patients (75%) had pre-existing diabetes, with mean glucose 468 mg/dL and HbA1c 13.7%.
  • Basal ganglia hyperintensity on MRI was observed in 80% of cases; 73.9% of patients resolved symptoms with treatment (insulin +/- anti-chorea meds) in a mean of 36.7 days.

Conclusions:

  • Hyperglycemic chorea is an important consideration in elderly patients presenting with acute chorea and uncontrolled diabetes.
  • Early recognition and aggressive glycemic control are paramount for symptom resolution.
  • Neuroimaging (MRI) is vital for diagnosis, and pharmacotherapy can assist in managing symptoms.

Keywords:
Hyperglycemiachoreadiabetes mellitusdiabetic striatopathyhemiballismus

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