RESUMEN
Hemiballism/Hemichorea (HH) is a hyperkinetic movement disorder observed mostly after cerebrovascular diseases in elderly patients. Even though the improvement in symptoms would be maintained without treatment, in rare cases, lesioning or DBS (deep brain stimulation) surgery provide a chance on relieving the severe involuntary movements. HH is a more rarely reported entity as a diabetic complication and we encountered very few cases treated with surgical intervention for diabetic HH. A 75-year-old female patient with type-II diabetes mellitus was admitted for left-sided disabling involuntary movement despite being medically treated for six months. A GPi (globus pallidus internus) and thalamic Vim (ventral intermediate) nucleus targeted DBS surgery was performed. Complete resolution was achieved with combined stimulation at 1.7â¯mA of thalamic Vim nucleus and 2.4â¯mA of GPi. Combined stimulation of thalamic Vim nucleus and GPi resulted in an effective treatment method for HH secondary to diabetes in our case. Even if the rarity of the cases treated surgically withholds us to come to a certain conclusion, it provides a new option to treat HH to our experience.
RESUMEN
Resumen La diabetes mellitus es una enfermedad de alta prevalência, así como también lo son sus complicaciones agudas. Una de ellas es el estado hiperosmolar no cetósico que raramente se asocia con alteraciones involuntarias del movimiento. Sin embargo, existe una condición que asocia alteraciones glucémicas con desórdenes del movimiento, denominado síndrome de corea hiperglicemia y ganglios basales, de la cual presentamos un caso y hacemos revisión de la literatura.
Abstract Diabetes mellitus is a disease of high prevalence, as well as its acute complications. One of them is the nonketotic hyperosmolar state that is rarely associated with involuntary changes in movement. However, there is a condition that associates glycemic alterations with movement disorders, called chorea hyperglycemia basal ganglia syndrome, of which we present a case and review the literature.
RESUMEN
La corea es un trastorno hiperquinético del movimiento. Puede producirse por una gran variedad de enfermedades genéticas, infecciosas, neurodegenerativas, metabólicas, autoinmunes, estructurales o secundarias a fármacos. Es una rara manifestación de lesiones vasculares cerebrales isquémicas o hemorrágicas, afectando habitualmente un hemicuerpo y formando parte del clásico síndrome lacunar de hemicorea-hemibalismo. Presentamos el caso de un paciente de sexo masculino de 67 años de edad con factores de riesgo cardiovasculares, que se presentó con un accidente cerebrovascular a forma de hemicorea vascular. Si bien dicha presentación está descrita en toda la bibliografía, es importante por su baja frecuencia lo cual hace que la mayoría de los médicos clínicos nunca hayan estado en contacto con pacientes portadores de dicha entidad.
Chorea is a hyperkinetic movement disorder. It can be caused by a great variety of conditions: genetic, infectious, degenerative, metabolic, autoimmune, structural or related to drugs. A rare manifestation of brain vascular lesions, either isquemic or hemorrhagic, it generally affects one side of the body as part of the classic hemichorea-hemibalism lacunar syndrome. We present the case of a 67 year old male with risk factors for cardiovascular disease, admitted with the diagnosis of vascular hemichorea as the manifestation of a stroke. Although such presentation is described in most of our bibliography, it is important because of its low prevalence and, consequently, the fact that most general physicians have never had contact with patients suffering from this entity.
