Recurrent Hypoglycemia-induced Hemiballism with Self-limited after Sleep - A Case Report.

PURPOSE: Hemiballism caused by hypoglycemia is rare. We presented a case who suffered from episodic hemiballism induced by hypoglycemia with spontaneously recovery after sleep. The possible mechanism of these self-limited episodes was also discussed. CASE REPORT: An 82-year-old female diabetic patient took oral anti-diabetic drugs (OADs) regularly. The doctor changed OADs doses and her appetite became poor before admission. She suffered from episodic left side involuntary movements with consciousness disturbance, and recovered spontaneously after a six-to-eight hour sleep in every attack at home. Very low finger sugar (20 mg/ dl) was noted while attack at admission. Brain computed tomography (CT), magnetic resonance imaging (MRI) and electroencephalography (EEG) were non-remarkable. Brain technetium-99mlabeled ethyl cysteinate dimer single-photon emission computed tomography (Tc-99m-ECD SPECT) showed relative hyperperfusion over right side basal ganglion and thalamus. No further involuntary movement was observed after better sugar control. CONCLUSION: We suppose that sleep modify the glucose counterregulatory responses with increased growth hormone, which salvage hypoglycemic status in our presented case. With this report, we would like to draw clinicians' attention to including the treatable hypoglycemia state in the differential diagnosis of episodic involuntary movements.