Non-ketotic hyperglycemic hemichorea
Presented with a history of weakness and jerking movements of left upper and lower limbs for 20 days. There were also stroke-like symptoms and several vomiting episodes. The patient was known case of type 2 diabetes mellitus diagnosed 6 months ago.
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Non-contrast MR demonstrates T1 hyperintensity of the right lentiform and caudate nuclei (basal ganglia) with the mild hyperintense signal on axial T2 and FLAIR images. No obvious blooming on T2 GRE and no abnormal signal seen on diffusion-weighted images (DWI). No mass effect was noted.
There is also periventricular T2/FLAIR hyperintense foci due to moderate chronic small vessel ischemic changes.
Findings most suggestive of non-ketotic hyperglycemia.
Laboratory investigations showed blood glucose level of 460 mg/dL. No ketone bodies were seen in urine. HbA1C was 14.2%. The patient was started on insulin and abnormal movements of the left upper and lower limbs disappeared completely a month later.
Non-ketotic hyperglycemic hemichorea is a clinical and radiological diagnosis and proper patient history is needed to arrive at a correct diagnosis.