Ischemic Stroke Presenting with Hemichorea: A Case Series

Background: Hemichorea is a rare hyperkinetic movement disorder that may occur as a complication of ischemic stroke or metabolic disturbances, particularly non-ketotic hyperglycemic hyperosmolar state (NKHHS). Case Series: We present two female patients with uncontrolled type II diabetes mellitus who developed hemichorea associated with ischemic stroke. The first case showed severe hyperglycemia (>500 mg/dL) without radiological abnormalities on non-contrast CT scan. The second case presented with hyperglycemia (375 mg/dL) and a hyperdense lesion in the left caudate nucleus. Both patients received aspirin and insulin, while symptomatic management included haloperidol and, in the second case, additional valproic acid. Both patients demonstrated gradual clinical improvement. Discussion: Post-stroke hemichorea is reported in only 1–4% of cases. The underlying mechanism involves disruption of the striato-thalamo-cortical pathway and, in hyperglycemia, impairment of GABA metabolism. Most cases respond well to glycemic control, although neuroleptics or antiepileptics may be necessary to control symptoms. Conclusion: This case series highlights that hemichorea can be a rare manifestation of ischemic stroke, either with or without radiological evidence, and may be aggravated by uncontrolled hyperglycemia. Early diagnosis, strict glycemic regulation, and appropriate symptomatic treatment are crucial for favorable outcomes. Keywords: Ischemic stroke, hemichorea, hyperglycemia