Chorea, Hyperglycemia, Basal Ganglia Syndrome in Diabetes – Two Rare Case Reports

Neurological manifestations of diabetes are protean. Hyperglycaemia induced involuntary movements (HIIM) are uncommon manifestations of diabetes seen especially in those with poor glycaemic control. Of these, basal ganglia syndrome (C-H-BG) is a rare entity which can mislead the unwary. Awareness and prompt recognition of C-H-BG syndrome is crucial, since correction of hyperglycaemia can lead to favourable clinical and radiological improvement. In this article, we report two patients presenting with C-H-BG syndrome on a background of poor glycaemic control. The clinical features of these two elderly diabetic females were characterized by hemichorea-hemiballismus in the first patient and generalised bilateral chorea/ballism in the second one. Radiologic findings associated with C-H-BG syndrome were characterized by hyperattenuation and hyperintensity on T1-weighted magnetic resonance imaging (MRI) at bilateral basal ganglion regions in both cases. Strict glycaemic control formed the corner stone of treatment for the two cases. The prognosis of nonketotic hyperglycemia-induced hemichorea-hemiballism is good and depends on the prompt recognition and optimal glycaemic control in diabetic patients.