Non-ketotic hyperglycemic hemichorea

Case contributed by Shu Su
Diagnosis almost certain


Acute on chronic confusion in setting of hyponatremia and polydipsia. History of Type 2 diabetes mellitus and hyperglycemic at time of admission.

Patient Data

Age: 74
Gender: Female

CT Brain


Hyperdensity of the caudate nucleus and lentiform nuclei, more prominent on the right. No edema or mass effect. Grey-white matter differentiation is preserved; internal capsule remains visible. Overall ventricular size sulcal patterns are age appropriate. No subarachnoid or subdural hemorrhage. No established acute infarct identified. Probable small bilateral lacunar infarcts, similar to previous CT. No suspicious osseous lesions.

Case Discussion

Whilst hyperdensity of the caudate nucleus and lentiform by itself is a non-specific sign, the patient was also found to be hyperglycemic at time of presentation and demonstrated typical hemiballismic chorea movements on the contralateral side. This makes the diagnosis of non-ketotic hyperglycemic hemichorea almost certain. 

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