SUN-615 - A Dangerous Dance with Glucose: A Case of Non-Ketotic Hyperglycemic Hemichorea in A Patient with Uncontrolled Type 2 Diabetes

Non-ketotic hyperglycemic hemichorea/hemiballismus (NKHHC) is a rare hyperkinetic movement disorder seen in the setting of poorly controlled diabetes mellitus. It is characterized by acute onset unilateral involuntary movements and, in typical cases, contralateral basal ganglia abnormalities on neuroimaging. Prompt recognition and aggressive glycemic control usually lead to symptom improvement, underscoring the importance of considering NKHHC in the differential diagnosis of acute movement disorders in diabetic patients. Here we report a case of a 72 year old female with uncontrolled diabetes presenting acute-onset involuntary movements of the right upper and lower extremities that started one day prior to presentation. Non-contrast CT of the brain demonstrated minimal hyperdensity involving the left basal ganglia, and MRI of the brain without contrast showed T1 hyperintensity in the left basal ganglia—classical imaging findings associated with NKHHC. The patient’s clinical condition and symptoms improved with improved glycemic control. This case underscores the importance of considering NKHHC as a rare but possible diagnosis in patients with uncontrolled diabetes presenting with acute unilateral movement disorders. Early recognition and prompt metabolic correction can lead to improvement, and often resolution of symptoms. This case reinforces the need for strict glycemic control in patients with long-standing diabetes to prevent rare but debilitating neurologic complications.

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