Hyperosmolar non-ketotic hyperglycaemia: an important and reversible cause of acute bilateral ballismus.
An 83-year-old lady with type 2 diabetes mellitus was admitted to hospital with pneumonia. After 3 days of oral amoxicillin she developed ballism-choreiform movements of all four limbs. Her serum glucose and osmolality were raised. She had no factors suggestive of genetic or iatrogenic causes. A CT scan of the brain revealed bilateral putamen hyperintensities. She was started on tetrabenazine and subcutaneous insulin, which led to complete resolution of her symptoms.
The Walton Centre NHS Trust, Liverpool, UK. philmilburnmcnulty@gmail.com
Philip
P
Milburn-McNulty
Benedict D
BD
Michael
Henry J
HJ
Woodford
Andrew
A
Nicolson
D000208:Acute Disease; D018759:Adrenergic Uptake Inhibitors; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy; D020820:Dyskinesias / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000150:complications* / Q000188:drug therapy; D007328:Insulin / Q000627:therapeutic use; D009994:Osmolar Concentration; D013747:Tetrabenazine / Q000627:therapeutic use
D018759:Adrenergic Uptake Inhibitors; D007328:Insulin; D013747:Tetrabenazine