Non-ketotic hyperglycemic hemichorea

Case contributed by Joan Perelló Garcia
Diagnosis certain

Presentation

One week history of spontaneous movements of the left upper and lower limbs.

Patient Data

Age: 50 years
Gender: Male

Marked hyperdensity in the head of the right caudate and the right lenticular nucleus.

There is no significant mass effect or perilesional edema.

MRI obtained 6 days later

mri

Unilateral hyperintensity of the right lenticular nuclei and head of the caudate.

The MRI scan had to be discontinued as a foreign body artifact was observed in the right eyelid region.

The patient was unaware of the origin of the foreign bodies and related it to having worked with a brushcutter.

8 months after initial CT

ct

Follow-up CT scan shows practical resolution of the right basal ganglia hyperdensity.

Case Discussion

Based on the initial CT scan, the diagnosis of hyperglycemic non-ketotic hemicorhea was suggested, despite no known history of diabetes mellitus. An MRI scan was recommended to complete the study.

After the CT scan, blood glucose levels were assessed, obtaining values of 340 mg/dL. An HbA1c value of 15.4% was obtained during hospital stay.

Although the MRI was not completed, T1 hyperintensity of the putamen and caudate nuclei was observed, which is the main MRI finding supporting the diagnosis.

The patient was discharged with a diagnosis of type 2 diabetis mellitus, and the hemicorea symptoms gradually resolved with insulin treatment.

Eight months after hospital discharge, a follow-up CT scan was performed, which showed practical resolution of the basal ganglia hyperdensity.

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