title: Hemichorea in a patient with diabetic ketoacidosis.
abstract: BACKGROUND
  Chorea is a common presenting feature of metabolic disorders, including nonketotic hyperglycemia in patients with type 2 diabetes mellitus, but rarely has been reported in diabetic ketoacidosis, hypothyroidism and vitamin B12 deficiency.
  
  
  METHODS
  Review the literature for reported cases of chorea as a presenting manifestation in metabolic disorders.
  
  
  RESULTS
  We report a case of hemichorea in a patient with type 2 diabetes mellitus complicated by diabetic ketoacidosis. The patient had a two day history of right sided hemichorea and decreased level of consciousness. Initial laboratory studies revealed hyperglycemia, ketosis and an anion gap metabolic acidosis consistent with diabetic ketoacidosis. Once treatment was started the choreiform movements significantly improved over three weeks.
  
  
  CONCLUSIONS
  Although DKA has been rarely reported as a trigger for chorea, it should be in the differential diagnosis of a patient presenting with an acute chorea. Given the reversible nature of this disease, early recognition and treatment are imperative.
authors.affiliation: The University of Texas Medical Branch, Galveston, TX, United States.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Yassin
authors.affiliation: The University of Texas Medical Branch, Galveston, TX, United States. Electronic address: shshroff@utmb.edu.
authors.forename: Sheetal
authors.initials: S
authors.lastname: Shroff
authors.affiliation: The University of Texas Medical Branch, Galveston, TX, United States.
authors.forename: Shreshta D
authors.initials: SD
authors.lastname: Patel
authors.affiliation: Massachusetts General Hospital, Boston, MA, United States.
authors.forename: Asif M
authors.initials: AM
authors.lastname: Paker
authors.affiliation: The University of Texas Medical Branch, Galveston, TX, United States.
authors.forename: Megan A
authors.initials: MA
authors.lastname: Berman
authors.affiliation: Baylor College of Medicine, Houston, TX, United States.
authors.forename: George R
authors.initials: GR
authors.lastname: Jackson
mesh_terms: D000368:Aged; D002819:Chorea / Q000150:complications* / Q000175:diagnosis*; D016883:Diabetic Ketoacidosis / Q000150:complications* / Q000175:diagnosis*; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male
keywords: Basal ganglia; Chorea; Diabetic ketoacidosis; Hypothyroidism; Non-ketotic hyperglycemia; Vitamin B12 deficiency