Disclosures: John D. Peters, MD: No financial relationships or conflicts of interest

Case Description: 82 year-old pre-diabetic female presented to acute care hospital with six-day history of uncontrollable, writhing/jerking movements in the left arm, noted to occur in similar frequency while awake as sleep. On presentation, she was found to have blood glucose (BG) over 400 and hemoglobin A1c 14.5, previously diagnosed only with diet treated pre-diabetes. CT Head evident of bilateral basal ganglia calcifications. BGs were treated and she was transferred upgraded to higher level of care, where physical exam was notable for moderate athetosis of the left arm, mild athetosis in the left leg, with full strength in both upper and lower extremities. She was started on amantadine, without improvement in athetosis, and metformin/tradjenta for diabetes. Due to ongoing functional impairments, physiatry was consulted and patient was admitted to acute inpatient rehabilitation.

Setting: Tertiary care hospital in an Academic center

Patient: 82 year-old female Assessment/

Results: During admission to rehab, patient progressed well from total assist with ambulation to walking minimum assist, and supervision in most ADLs, from minimum to moderate assist. She benefitted from balance training and cardiovascular rehab. Tight control of her BGs decreased her choreo-athetoid movements significantly.

Discussion: Hemi-chorea elucidated by newly diagnosed non-ketotic hyperglycemia is a documented, but rare phenomenon, seen often with CT hyperdensity in the basal ganglia. This hyperdensity has been ascribed to hemorrhage and metal deposits. Interestingly, ischemia that does not lead to full stroke results in deposition of manganese ions in astrocytes that can cause this hyperdensity. However, no authoritative explanation thus far exists. Further studying of this phenomenon is necessary to better address, treat the hemibalism, and improve functional outcomes.

Conclusion: This patient demonstrates a significant deviation in the archetype of this phenomenon. Her integration into rehabilitation, in addition to tight glycemic control, was key to her progression from dependence to near-independence and symptomatic freedom.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/hemi-chorea-emerging-a-case-of-basal-ganglia-calcifications-in-a-hyperglycemic-patient/