CASE REPORT: HEMICHOREA-HEMIBALLISMUS IN NONKETOTIC HYPERGLYCEMIC FEMALE PATIENT: PUTAMINAL HIGH INTENSITY LESION ON MRI T1-WEIGHTED IMAGES

A 65-year-old female known case of diabetes mellitus type 2, hypertension, chronic heart failure and chronic renal failure was admitted to our hospital with fever, diarrhea, and sudden onset of hemichorea-hemiballismus in right upper limb and lower limb. On admission blood glucose level was 175mg/dl, hemoglobin A1c was 11% and the serum osmolality was 292 mOsm/l. Urine analysis was negative for glucose and ketone bodies. After correction of blood glucose to normal level choreiform and ballistic movements disappeared. MRI showed high intensity on T1-weighted images in the left putamen, which disappeared 4 months after onset. The putaminal abnormality was the cause of her involuntary movements. The cause of high intensity in the putamen might be the multiple petechial hemorrhages which can occur in association with nonketotic hyperglycemia. We report an occurrence of hemichorea-hemiballismus in a female patient with diabetes mellitus type 2.