title: Acute hemichorea in a newly diagnosed type II diabetes patient: a diagnostic challenge in resource-limited setting: a case report.
abstract: BACKGROUND
  Chorea is a rare complication of uncontrolled type II diabetes. We report for the first time in Tanzania a case of type II diabetes presenting with a hyperglycaemia-induced hemichorea.
  
  
  METHODS
  A 58-year-old Tanzanian chagga by tribe with a body mass index of 28 kg/m(2) and newly diagnosed type II diabetes presented with polydipsia and involuntary movements of the right upper limb for 4 days. His plasma glucose was 549 mg/dl and glycated haemoglobin was 18.9 %. His movements were exaggerated by attempts to use his right hand. The rest of his neurological assessment was unremarkable. Other laboratory findings including calcium were within the normal range. A computed tomography scan of the brain was essentially normal except for age-related atrophy. There was no significant ketonuria on urine dipstick testing. We treated the patient's hyperglycaemia with intravenous insulin and the dystonia disappeared within 5 days.
  
  
  CONCLUSIONS
  Hemichorea is among the rare complications of hyperglycaemia-induced involuntary movements. Hyperglycaemia should be considered as a differential diagnosis for patients with type II diabetes mellitus presenting with hemichorea upon clinical assessment.
authors.affiliation: Department of Internal Medicine, Kilimanjaro Christian Medical Centre, PO BOX 3010, Moshi, Tanzania.|Kilimanjaro Christian Medical University College, Tumaini University Makumira, PO BOX 2240, Moshi, Tanzania.
authors.forename: Flora
authors.initials: F
authors.lastname: Ruhangisa
authors.affiliation: Department of Internal Medicine, Kilimanjaro Christian Medical Centre, PO BOX 3010, Moshi, Tanzania.
authors.forename: Henry
authors.initials: H
authors.lastname: Stephen
authors.affiliation: Department of Internal Medicine, Kilimanjaro Christian Medical Centre, PO BOX 3010, Moshi, Tanzania.
authors.forename: Jacob
authors.initials: J
authors.lastname: Senkondo
authors.affiliation: Department of Internal Medicine, Kilimanjaro Christian Medical Centre, PO BOX 3010, Moshi, Tanzania.|Kilimanjaro Christian Medical University College, Tumaini University Makumira, PO BOX 2240, Moshi, Tanzania.|Kilimanjaro Christian Medical Centre, Endoscopy Unit, PO BOX 3010, Moshi, Tanzania.|Better Human Health Foundation, PO BOX 1348, Moshi, Tanzania.
authors.forename: Amos
authors.initials: A
authors.lastname: Mwasamwaja
authors.affiliation: Department of Internal Medicine, Kilimanjaro Christian Medical Centre, PO BOX 3010, Moshi, Tanzania.|Kilimanjaro Christian Medical University College, Tumaini University Makumira, PO BOX 2240, Moshi, Tanzania.
authors.forename: Said
authors.initials: S
authors.lastname: Kanenda
authors.affiliation: Department of Internal Medicine, Kilimanjaro Christian Medical Centre, PO BOX 3010, Moshi, Tanzania.|Kilimanjaro Christian Medical University College, Tumaini University Makumira, PO BOX 2240, Moshi, Tanzania.
authors.forename: Saleh
authors.initials: S
authors.lastname: Mbarak
authors.affiliation: Department of Internal Medicine, Kilimanjaro Christian Medical Centre, PO BOX 3010, Moshi, Tanzania.|Kilimanjaro Christian Medical University College, Tumaini University Makumira, PO BOX 2240, Moshi, Tanzania.
authors.forename: Nyasatu
authors.initials: N
authors.lastname: Chamba
authors.affiliation: Department of Internal Medicine, Kilimanjaro Christian Medical Centre, PO BOX 3010, Moshi, Tanzania.|Kilimanjaro Christian Medical University College, Tumaini University Makumira, PO BOX 2240, Moshi, Tanzania.
authors.forename: Kajiru
authors.initials: K
authors.lastname: Kilonzo
authors.affiliation: Department of Internal Medicine, Kilimanjaro Christian Medical Centre, PO BOX 3010, Moshi, Tanzania.|Kilimanjaro Christian Medical University College, Tumaini University Makumira, PO BOX 2240, Moshi, Tanzania.
authors.forename: William
authors.initials: W
authors.lastname: Howlett
authors.affiliation: Department of Internal Medicine, Kilimanjaro Christian Medical Centre, PO BOX 3010, Moshi, Tanzania.|Kilimanjaro Christian Medical University College, Tumaini University Makumira, PO BOX 2240, Moshi, Tanzania.
authors.forename: Isaack
authors.initials: I
authors.lastname: Lyaruu
authors.affiliation: Department of Internal Medicine, Kilimanjaro Christian Medical Centre, PO BOX 3010, Moshi, Tanzania. Elichilia2004@yahoo.co.uk.|Kilimanjaro Christian Medical University College, Tumaini University Makumira, PO BOX 2240, Moshi, Tanzania. Elichilia2004@yahoo.co.uk.|Better Human Health Foundation, PO BOX 1348, Moshi, Tanzania. Elichilia2004@yahoo.co.uk.|Imagedoctors International, PO BOX 16341, Arusha, Tanzania. Elichilia2004@yahoo.co.uk.
authors.forename: Elichilia
authors.initials: E
authors.lastname: Shao
mesh_terms: D000208:Acute Disease; D002819:Chorea / Q000150:complications* / Q000000981:diagnostic imaging; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006295:Health Resources; D006801:Humans; D006943:Hyperglycemia / Q000150:complications; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
keywords: Diabetes mellitus type II; Hemichorea; Resource-limited