%0 Journal Article
%T Nonketotic Hyperglycemic Chorea
%A Mahmoud Abdelghany
%A Samuel Massoud
%J Case Reports in Neurological Medicine
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/128037
%X This is a unique case of nonketotic hyperglycemic (NKH) chorea in a 34-year-old white male. The patient had a poorly controlled type 2 diabetes mellitus (DM) due to medication incompliance. He complained of polyuria, polydipsia, and weight loss of 20 pounds within a month before presentation. T2-weighted (T2W) MRI showed hyperintensity in the left basal ganglion. Glycated hemoglobin (HBA1c) was 13.6%. The patient was started on insulin and clonazepam and the chorea resolved after proper control of the glucose level. To our knowledge, this is the first reported case of NKH chorea in a young white male with high T2-weighted (T2W) magnetic resonance signal in the basal ganglia. 1. Introduction Chorea is an irregular, poorly patterned, involuntary movement disorder. Various conditions such as cerebrovascular insufficiency, neurodegenerative diseases, neoplastic diseases, immunological diseases, infectious diseases, and metabolic diseases are known as secondary causes of this rare disorder [1]. Hyperglycemia is the most common metabolic cause of chorea-ballism [2]. NKH chorea is more common in elderly patients [2¨C5] especially females from East Asian origin [3, 5]. Proper control of DM, with or without neuroleptic drugs, is the key for treatment. 2. Case A 34-year-old white male presented to our hospital complaining of 1 month of flailing-like movements of his right upper extremity that progressed to the whole right side of the body and his neck. He also complained of a 20-pound weight loss within a month before presentation accompanied by polyuria and polydipsia. The patient denied any loss of consciousness, weakness, difficulty walking, headaches, blurry vision, slurred speech, fever, chills, or recent flu-like symptoms. He also denied taking any neuroleptic drugs. His past medical history was significant for type 2 DM for which he was on insulin but had not been taking it for a year because of financial problems. Physical exam showed mild hypotonia in the right upper extremity with no weakness in all extremities. Laboratory investigations showed blood sugar around 230£¿mg/dL, with no anion gap. HBA1c was 13.6%. Urine drug screening was negative. CT scan of the head did not show any abnormalities. MRI of the brain (Figures 1, 2, 3, 4, and 5) showed high T2W signal in both putamina of the basal ganglia and low T1 weighted (T1W) signal in the left putamen of the basal ganglion with no restricted diffusion on the axial diffusion weighted imaging (DWI). Thyroid stimulating hormone, antinuclear antibody, antiphospholipid antibody, liver function tests,
%U http://www.hindawi.com/journals/crinm/2014/128037/