Chorea in Non-Ketotic Hyperglycemia

Chorea is an involuntary, irregular, poorly patterned movement that is associated with a wide variety of illnesses. In this case, we describe a 71-year-old female who presented with choreiform movements after a change to her diabetes medication regimen. The patient was found to have non-ketotic hyperglycemia and was admitted to the hospital for insulin and rehydration. Once the patient’s blood glucose was controlled, her choreiform movements resolved. MRI showed no abnormal findings. In previous case reports, MRI showed hyperintense lesions in the putamen. Although the pathophysiology behind this finding is unclear, several mechanisms have been hypothesized including dopamine hypersensitivity and GABA depletion. We present this case in order to demonstrate the need to consider non-ketotic hyperglycemia in a patient with new onset choreiform movements without typical MRI findings.