Case Study: 62-Year-Old Woman with Abnormal Movement of the Left Arm, Nonketotic Hyperglycemic Hemichorea (NH-HC)
Nonketotic Hyperglycemic Hemichorea 1. Cause Nonketotic hyperglycemic hemichorea is caused by severe hyperglycemia without significant ketosis . The condition predominantly affects elderly individuals with type 2 diabetes mellitus and is characterized by unilateral chorea or hemiballismus , which are involuntary, rapid, and irregular movements on one side of the body. 2. Etiology Underlying disease : Long-standing or newly diagnosed type 2 diabetes mellitus. Precipitating factor : Extreme hyperglycemia (often >300 mg/dL) without ketosis or acidosis. Metabolic dysfunction : Thought to cause energy depletion in the basal ganglia, particularly the striatum (caudate and putamen). Demographic predisposition : Most common in elderly women of Asian descent , but can occur in any population. 3. Pathophysiology The precise mechanism is not fully understood, but several hypotheses have been proposed: Metabolic insult to t...