Case Report: Non-Ketotic Hyperglycemia Hemichorea-Hemiballismus in the Emergency Department

Non-ketotic hyperglycemia hemichorea-hemiballismus (NH-HC), also known as diabetic striatopathy, is a rare condition characterized by glucose levels greater than 200 mg/dL and continuous, involuntary, and irregular large amplitude jerky movements localized predominantly to one side of the body called hemichorea-hemiballismus. While the differential diagnosis of irregular movements is vast, including seizures disorder, stroke, tumors, Tourette’s syndrome and rheumatic fever, clinicians should also consider diabetic striatopathy as a differential as it has very good prognosis and is easily treatable if diagnosed early. Here we discuss the case of a 72 year-old male with history of non-insulin dependent type 2 diabetes (T2DM), who presented to the emergency department awake, alert, and oriented complaining of intermittent left arm jerking and mild weakness x 3 days, who was subsequently found to have glucose of >1000 and HBA1C >14, was hospitalized, treated with insulin for 2 days with complete resolution of symptoms.