Uncontrollable movements in patient with diabetes mellitus

Our patient had poorly controlled diabetes, and her HC-HB was a rare complication of nonketotic hyperglycemia. Between 1985 and 2001, only 53 case reports of this condition were published.2 The underlying pathophysiology leading to basal ganglia dysfunction is multifactorial. Recent imaging studies have shown reduced cerebral glucose metabolism on positron emission tomography (PET) scans, with concomitant hyperperfusion in the affected basal ganglia seen on single photon emission computed tomography (SPECT). These findings may suggest a local failure in vascular autoregulation in the setting of pre-existing microangiopathic disease and recurrent metabolic derangements.3 Hemichorea-hemiballismus (HC-HB) is a spectrum of involuntary, continuous, nonpatterned movements of one side of the body. It can be caused by a focal lesion of the contracterai basal ganglia or a diffuse systemic process (Box 1). Other abnormal movements must be distinguished from HC-HB (Table 1). Also, the possibility of continuous focal seizures (epilepsia partialis continua [EPC]) causing unilateral movements must be considered. EPC can occur secondary to hyperglycemia; however, the movements are usually regular and rhythmic and often have corresponding electroencephalogram abnormalities. EPC is often associated with cortical lesions rather than subcortical (basal ganglia) lesions. As a result, electroencephalography and brain MRI scanning are helpful in distinguishing these 2 entities, when history and examination do not provide sufficient information.1