Posters
Academic Level (Author 1)
Medical Student
Discipline/Specialty (Author 1)
Neurology
Discipline Track
Patient Care
Abstract
Introduction: Uncontrolled blood glucose is notorious for inflicting multi-organ pathologies. One such pathology, chorea-hemiballism, has been reported in individuals who exhibited either hyperglycemia or hypoglycemia, and although rare, it is debilitating and calls for active management.
Case Description: A 50-year-old female, with a past medical history of anemia, chronic kidney disease, type 2 diabetes mellitus, and hypertension, presented to the emergency room with acute onset chorea-hemiballism. Patient reported experiencing abnormal movements for two weeks prior to her ER visit, but otherwise denied prior episodes of movement disorders. On physical examination, patient displayed generalized jerky choreiform movements of upper and lower extremities, face, and neck. Upon admission, patient’s blood glucose level was at 311mg/dL; CT of the head was unremarkable and an EEG revealed no abnormalities. The following day, it was found that her blood glucose levels ranged from 150mg/dL to 309mg/dL during the day, and at night, her glucose levels would consistently drop as low as 40mg/dL. Patient underwent an MRI of the head, which revealed no evidence of an acute infarct. The next day, patient’s chorea had improved substantially, although this improvement is most likely attributed to the haloperidol she received prior to the MRI scan. Given her wildly fluctuating blood glucose levels, there was suspicion the chorea-hemiballism was a result of either hypoglycemia or hyperglycemia; however, in the past, patient was admitted to the ER for severe hypoglycemia on numerous occasions and she did not present with chorea during these episodes. Patient was started on olanzapine 2.5mg at bedtime as an empiric management for chorea.
Discussion: Very few cases have illustrated chorea-hemiballism in diabetic patients, but even fewer have depicted such a condition in individuals with negative imaging and with labile glucose levels. This case suggests a rare but far-reaching effect of uncontrolled blood glucose levels.
Presentation Type
Poster
Recommended Citation
Akkineni, Bhargavi and Torres, Karina, "A Case of Chorea-Hemiballism in the Presence of Labile Glucose Levels" (2023). Research Colloquium. 51.
https://scholarworks.utrgv.edu/colloquium/presentation/poster/51
Included in
A Case of Chorea-Hemiballism in the Presence of Labile Glucose Levels
Introduction: Uncontrolled blood glucose is notorious for inflicting multi-organ pathologies. One such pathology, chorea-hemiballism, has been reported in individuals who exhibited either hyperglycemia or hypoglycemia, and although rare, it is debilitating and calls for active management.
Case Description: A 50-year-old female, with a past medical history of anemia, chronic kidney disease, type 2 diabetes mellitus, and hypertension, presented to the emergency room with acute onset chorea-hemiballism. Patient reported experiencing abnormal movements for two weeks prior to her ER visit, but otherwise denied prior episodes of movement disorders. On physical examination, patient displayed generalized jerky choreiform movements of upper and lower extremities, face, and neck. Upon admission, patient’s blood glucose level was at 311mg/dL; CT of the head was unremarkable and an EEG revealed no abnormalities. The following day, it was found that her blood glucose levels ranged from 150mg/dL to 309mg/dL during the day, and at night, her glucose levels would consistently drop as low as 40mg/dL. Patient underwent an MRI of the head, which revealed no evidence of an acute infarct. The next day, patient’s chorea had improved substantially, although this improvement is most likely attributed to the haloperidol she received prior to the MRI scan. Given her wildly fluctuating blood glucose levels, there was suspicion the chorea-hemiballism was a result of either hypoglycemia or hyperglycemia; however, in the past, patient was admitted to the ER for severe hypoglycemia on numerous occasions and she did not present with chorea during these episodes. Patient was started on olanzapine 2.5mg at bedtime as an empiric management for chorea.
Discussion: Very few cases have illustrated chorea-hemiballism in diabetic patients, but even fewer have depicted such a condition in individuals with negative imaging and with labile glucose levels. This case suggests a rare but far-reaching effect of uncontrolled blood glucose levels.