VCOM Louisiana Research Day Program

Clinical & Case Studies

Apoorva Kondapally, MD; Melissa Albritton, MD; Vaneeza Mukhtar, OMS-III Willis Knighton Health System, Shreveport, Louisiana 23 HEMIBALLISMUS AS A RARE PRESENTATION OF LONG – STANDING UNDIAGNOSED HYPERGLYCEMIA

Central nervous system dysfunction is an uncommon and late complication of long-term uncontrolled hyperglycemia. Hemiballismus is a movement disorder caused by a contralateral lesion of the basal ganglia. Consisting of violent, jerky, and involuntary high amplitude movements of the ipsilateral limbs, it is characterized as a rare and severe condition. Common causes of hemiballismus include stroke, hemorrhage, infection, drug abuse, and neoplasms. We report a case of a 58-year-old male patient who exhibited unilateral hemiballismus in his left arm and leg due to long standing undiagnosed Type II Diabetes. The patient presented to a neurology clinic with complaints of sudden onset jerky movements in the left upper and lower extremities. On initial evaluation, was found to have a significantly elevated glucose level at 326 mg/dL and hemoglobin A1C of 11.8% and was diagnosed with Type II Diabetes. An MRI depicted a high T1 signal involving the right neostriatum and minor involvement of the globus pallidus. A further diagnosis of hemiballismus due to uncontrolled Type II Diabetes was made. Strict hyperglycemic control along with tetrabenazine, led to a significant reduction of involuntary movements and depicted significant improvements in imaging studies as well.

This case examines the neurological complications of a patient with longstanding undiagnosed Type II Diabetes through lab work, imaging results and treatment regimens. We also highlight the importance of routine lab work for early diagnosis to avoid potentiating the risk for development of serious complications of undiagnosed Type II Diabetes. There is evidence in the literature that suggests a positive correlation between hyperglycemia and hemiballismus. However, there are not enough documented cases highlighting the significance of long-standing undiagnosed hyperglycemia leading to the development of hemiballismus. It is imperative to efficiently diagnose Type II Diabetes early prior to patients presenting in an unmanaged state to prevent disease progression which can lead to debilitating neurological manifestations.

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