{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T14:10:01Z","timestamp":1777039801225,"version":"3.51.4"},"reference-count":24,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2018,5,29]]},"abstract":"<jats:p>Non-ketotic hyperglycaemia (NKH) is the most common metabolic cause of hemichorea-hemiballismus (HC-HB) and an often-reversible condition. A 68-year-old man presented to the emergency department with a severe hyperglycaemic episode and altered mental status. He was treated appropriately and discharged home after his blood glucose levels were normal with an improvement of mental status. Four weeks after the discharge, he returned with flailing movements of bilateral upper and lower limbs. MRI of the brain revealed hyperintensities of the bilateral putamen on T1-weighted imaging. The patient<jats:bold>\u2019<\/jats:bold>s symptoms improved with a combination of amantadine, clonazepam and tetrabenazine. Several hypotheses involving gemistocytes, calcification and petechial haemorrhage were proposed in support of imaging abnormalities in the striatum. Dopamine-depleting agents and neuroleptics are used in the treatment of chorea. It is recommended to try a dose of tetrabenazine in patients with NKH-induced HC-HB if no improvement is appreciated with initial treatment of glycaemic control.<\/jats:p>","DOI":"10.1136\/bcr-2018-224856","type":"journal-article","created":{"date-parts":[[2018,6,20]],"date-time":"2018-06-20T03:54:59Z","timestamp":1529466899000},"page":"bcr-2018-224856","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Bilateral chorea\/ballismus: detection and management of a rare complication of non-ketotic hyperglycaemia"],"prefix":"10.1136","volume":"2018","author":[{"given":"Venkata Sunil","family":"Bendi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abhishek","family":"Matta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diego","family":"Torres-Russotto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Shou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,6,19]]},"reference":[{"key":"2025042703560071000_2018.jun18_1.bcr-2018-224856.1","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1989.00520440044020"},{"key":"2025042703560071000_2018.jun18_1.bcr-2018-224856.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-510X(02)00133-8"},{"key":"2025042703560071000_2018.jun18_1.bcr-2018-224856.3","first-page":"1057","article-title":"Chorea-ballismus with nonketotic hyperglycemia in primary diabetes mellitus","volume":"17","author":"Lai","year":"1996","journal-title":"AJNR Am J Neuroradiol"},{"key":"2025042703560071000_2018.jun18_1.bcr-2018-224856.4","doi-asserted-by":"crossref","first-page":"402","DOI":"10.5334\/tohm.291","article-title":"Hemichorea\/hemiballism associated with hyperglycemia: report of 20 cases","volume":"6","author":"Cosentino","year":"2016","journal-title":"Tremor Other Hyperkinet Mov"},{"key":"2025042703560071000_2018.jun18_1.bcr-2018-224856.5","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.10.6.619"},{"key":"2025042703560071000_2018.jun18_1.bcr-2018-224856.6","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1017\/S0317167100001608","article-title":"Transient hemichorea\/hemiballismus associated with new onset hyperglycemia","volume":"28","author":"Ifergane","year":"2001","journal-title":"Can J Neurol Sci"},{"key":"2025042703560071000_2018.jun18_1.bcr-2018-224856.7","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/107.2.579"},{"key":"2025042703560071000_2018.jun18_1.bcr-2018-224856.8","doi-asserted-by":"publisher","DOI":"10.1016\/0026-0495(75)90146-8"},{"key":"2025042703560071000_2018.jun18_1.bcr-2018-224856.9","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-004-0571-4"},{"key":"2025042703560071000_2018.jun18_1.bcr-2018-224856.10","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1097\/NRL.0b013e3182173528","article-title":"Blood-brain barrier disruption is involved in seizure and hemianopsia in nonketotic hyperglycemia","volume":"17","author":"Kim","year":"2011","journal-title":"Neurologist"},{"key":"2025042703560071000_2018.jun18_1.bcr-2018-224856.11","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.60.4.428"},{"key":"2025042703560071000_2018.jun18_1.bcr-2018-224856.12","first-page":"863","article-title":"Hemichorea-hemiballism: an explanation for MR signal changes","volume":"19","author":"Shan","year":"1998","journal-title":"AJNR Am J Neuroradiol"},{"key":"2025042703560071000_2018.jun18_1.bcr-2018-224856.13","first-page":"170","article-title":"Hemichorea-hemiballism associated with hyperintense putamen on T1-weighted MR images: an update and a hypothesis","volume":"13","author":"Shan","year":"2004","journal-title":"Acta Neurol Taiwan"},{"key":"2025042703560071000_2018.jun18_1.bcr-2018-224856.14","doi-asserted-by":"publisher","DOI":"10.1007\/BF00588571"},{"key":"2025042703560071000_2018.jun18_1.bcr-2018-224856.15","doi-asserted-by":"publisher","DOI":"10.12659\/PJR.890043"},{"key":"2025042703560071000_2018.jun18_1.bcr-2018-224856.16","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1007\/s40265-016-0670-4","article-title":"Current pharmacological approaches to reduce chorea in huntington\u2019s disease","volume":"77","author":"Coppen","year":"2017","journal-title":"Drugs"},{"key":"2025042703560071000_2018.jun18_1.bcr-2018-224856.17","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.48.2.358"},{"key":"2025042703560071000_2018.jun18_1.bcr-2018-224856.18","doi-asserted-by":"publisher","DOI":"10.1002\/mds.21100"},{"key":"2025042703560071000_2018.jun18_1.bcr-2018-224856.19","doi-asserted-by":"crossref","unstructured":"Umeh CC , Nichols P , Rosenthal LS , et al . Dual treatment of hemichorea-hemiballismus syndrome with tetrabenazine and chemodenervation. Tremor Other Hyperkinet Mov 2012;2.","DOI":"10.5334\/tohm.97"},{"key":"2025042703560071000_2018.jun18_1.bcr-2018-224856.20","doi-asserted-by":"crossref","first-page":"225","DOI":"10.5694\/j.1326-5377.1976.tb140550.x","article-title":"Clonazepam in the treatment of choreiform activity","volume":"1","author":"Peiris","year":"1976","journal-title":"Med J Aust"},{"key":"2025042703560071000_2018.jun18_1.bcr-2018-224856.21","doi-asserted-by":"publisher","DOI":"10.1002\/mds.20086"},{"key":"2025042703560071000_2018.jun18_1.bcr-2018-224856.22","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/S0887-8994(99)00104-6","article-title":"Gabapentin treatment in a child with delayed-onset hemichorea\/hemiballismus","volume":"22","author":"Kothare","year":"2000","journal-title":"Pediatr Neurol"},{"key":"2025042703560071000_2018.jun18_1.bcr-2018-224856.23","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1002\/mds.1135","article-title":"Abolition of postapoplectic hemichorea by Vo-complex thalamotomy: long-term follow-up study","volume":"16","author":"Goto","year":"2001","journal-title":"Mov Disord"},{"key":"2025042703560071000_2018.jun18_1.bcr-2018-224856.24","doi-asserted-by":"publisher","DOI":"10.1002\/mds.23967"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-224856","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T10:56:12Z","timestamp":1745751372000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-224856"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,6,19]]},"references-count":24,"alternative-id":["10.1136\/bcr-2018-224856"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-224856","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,6,19]]}}}