Hyperglycemia: An Unusual Cause for Hemichorea
A 35-year-old female came to the outpatient department with involuntary movements of the left half of the body since 3 days, progressive, preceded by a short febrile illness. Movements were sudden in onset and persisted throughout the day making it difficult for her to fall asleep. However they disappeared during sleep.\nThe patient was not known a diabetic or a hypertensive. There was no history of thyroid dysfunction and history of no similar episodes in the past.\nOn examination, the patient was vitally stable. The patient was having choreiform movements of left upper and lower limb. She could not voluntarily suppress the movements. Plantar reflex showed bilaterally flexor response. Sensory system was intact. Systemic examination of all other systems was unremarkable.\nInvestigations revealed that her blood counts, thyroid profile, liver function test, renal function test, serum electrolytes were all within the normal limits. Her Antistreptolysin O (ASLO) titer was also negative. Her random blood sugar was 572 mg/ dl. The patient was started on tab. Haloperidol 1 mg three times a day and was slowly uptitrated to 1.5 mg three times a day. Meanwhile the patient was also started on regular insulin of 8 units subcutaneously tid which was adjusted according to her blood sugars. The patient gradually improved with haloperidol and with control of her blood sugars. As her blood sugars were controlled, her choreiform movements subsided remarkably. It was decided to start Haloperidol as the movements were severe and disabling. Slit lamp examination was done which ruled out the presence of K-F ring. Her cranial CT scan was normal.\nHence a diagnosis of hemichorea due to hyperglycemia was made.