Hyperglycemia and chorea.

(A) Computed tomography of the brain showing no abnormal finding. (B) Magnetic resonance imaging of the brain showing a T1-weighted area of hyperintensity in the left putamen, caudate nucleus, and globus pallidum with sparing of the internal capsule (arrow). (C) T2*-weighted image showing hypointensity in the left putamen, caudate nucleus, and globus pallidum (arrowhead). (D) T2-weighted image showing no abnormal finding.

An 87‐year‐old female who had insulin‐dependent diabetes mellitus with a glycated hemoglobin level of 8.5% presented with altered consciousness due to hyperosmolar hyperglycemic state with blood glucose concentration of 1125 mg/dL and serum osmolality of 341 mOsm/L. One week after the treatment of the hyperglycemia, involving intravenous fluid administration, continuous infusion of insulin, and correction of electrolyte imbalances, the patient gradually regained consciousness but experienced involuntary movements of the right upper limb. Physical examination revealed right semidirected, nonrhythmic, irregular, and twisting movements, consistent with hemichorea (Video S1). A brain computed tomography showed no abnormal findings (Figure 1A). Magnetic resonance imaging of the brain showed a T1‐weighted area of hyperintensity and a T2*‐weighted area of hypointensity in the left caudate nucleus, and a part of the left putamen and globus pallidus, sparing the internal capsule (Figure 1B, arrow; and Figure 1C, arrowhead), with normal findings of T2‐weighted images (Figure 1D). We diagnosed diabetic chorea in this patient based on the clinical course and image findings. The patient's symptoms improved following the administration of haloperidol for a total of 2 months for early symptom control, without recurrence of the hemichorea during the entire follow‐up period of 4 months. Her diabetic control was good with intensive insulin therapy. Diabetic chorea is a neurological complication of hyperglycemia, such as hyperosmolar hyperglycemic state and diabetic ketoacidosis. The symptom improves with treatment of hyperglycemia in most cases. In addition, treatment includes not only dopamine antagonists such as haloperidol, but also tetrabenazine or topiramate.1, 2

Figure 1

A, Computed tomography of the brain showing no abnormal finding. B, Magnetic resonance imaging of the brain showing a T1‐weighted area of hyperintensity in the left putamen, caudate nucleus, and globus pallidum with sparing of the internal capsule (arrow). C, T2*‐weighted image showing hypointensity in the left putamen, caudate nucleus, and globus pallidum (arrowhead). D, T2‐weighted image showing no abnormal finding

CONFLICT OF INTEREST

The authors have stated explicitly that there are no conflicts of interest in connection with this article.

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