Hyperglycemic Induced Chorea-Ballismus Responsive to Valbenazine: a Video Case Report and Review of the Literature. (P4.7-008)

Objective: To describe a patient case report of delayed presentation of hyperglycemia induced chorea-ballismus that responded to dopamine depleting medication Valbenazine Background: Non-ketotic hyperglycemia is the second most common cause of acute onset chorea-ballismus, with typically associated lesions in the basal ganglia. The exact mechanism of hyperglycemia-induced chorea is unknown but is believed to be secondary to both decreased blood flow and depletion of aminobutyric acid that disproportionately affects the basal ganglia. In previously reported cases, patients present acutely symptomatic in the setting of elevated blood glucose. Design/Methods: The patient was started on medication Valbenazine with video recordings taken pre-treatment. The patient was called 24 hours after treatment to assess mediation tolerability and response. One month after treatment the patient was re-evaluated and a repeat video recording taken to assess medication response and disease course. Results: An 89-year-old woman of South East Asian descent who presented to outside hospital with altered mental status and found have was newly diagnosed uncontrolled diabetes and HgbA1c above 13. About six weeks after discharged from hosptial she started having progressive bilateral chorea-ballismus over a span of two weeks. Her blood sugar control was well managed after hospitalization. Patient presented to the emergency department with non-elevated blood sugars. MRI brain on presentation showed bilateral caudate and lentiform nucleus T1 hyperintense lesions. She was started on Valbenzine. The patient reported marked improvement in chorea-ballismus after 24 hours of treatment. Patient tolerated the medication and denied any significant side effects. One month post-treatment video demonstrated marked improvement with the vesicular monoamine transporter 2 inhibitor, Valbenazine. Conclusions: Our case report and videos demonstrate that hyperglycemia acquired form of chorea-ballismus can present atypically in a delayed fashion and is responsive to dopamine depleting agents. Disclosure: Dr. Saunders has nothing to disclose. Dr. Chen has nothing to disclose. Dr. Ng has nothing to disclose. Dr. Zhang has nothing to disclose.