Movement disorders: A complication of chronic hyperglycemia? A case report

Abstract Introduction The association of chorea with a specific lesion on brain imaging is described as an atypical manifestation of chronic hyperglycemia. Case report Patient of 77 years, hospitalized for bilateral choreic movements predominant on the right with dystonic movements, appeared a month ago. At admission Hyperglycemia at 2.4 g/L, without ketosis, a type 2 diabetes (HbA1c 17.3%) on oral antidiabetic agents. CT scan shows hyperdensity of putamen and lenticular nucleus that eliminates an ischemic attack. Evolution after glycemic reequilibration and treatment by haloperidol is favorable, with regression of chorea. Discussion This is a rare syndrome, affecting more elderly, presenting a diabetes poorly controlled. There is hyperglycemia without ketosis and moderate hyperosmolarity. The symptoms usually regress after glycemic control and neuroleptic treatment (recurrence in 13% of cases). The appearance of this syndrome seems to be related to the achievement of the control system GABAergic of the basal ganglia leading to an excitation of the cerebral cortex, causing involuntary movements. The etiopathogenic hypotheses advanced are multiple: impaired striatal neurotransmission associated with metabolic disturbances of hyperglycemia, dysfunction of the hematoencephalic barrier and abnormalities of the cerebral vascularization. Conclusion Chorea secondary to nonketotic hyperglycemia is a rare complication and little known of type 2 diabetes. Transitional neuroleptic treatment and glycemic control make the symptoms regress in most cases with the disappearance of the lesion imaging.