Background. Non-ketotic hyperglycemia chorea-hemiballismus involves irregular, involuntary movements from high blood sugar. Both hemorrhagic and ischemic strokes can cause movement disorders or seizures, complicating diagnosis since seizures may stem from either condition. The coexistence of diabetes and stroke complicates diagnosis and management due to limited literature on patients with both hemichorea and seizures.

Case Presentation. A 74-year-old male with poorly managed diabetes was admitted a year prior due to left sided numbness and weakness with gradual involuntary movements of left upper and lower limbs. Initially suspected of a cerebrovascular infarct, work-up and imaging showed hyperdense changes with possible hemorrhages but no distinct infarct. He was discharged on insulin, oral hypoglycemics, and an anti-cholinergic medications. HbA1c levels were maintained between 5.9% and 7.9% during follow-ups. Recently, he experienced right sided facial spasms with recurrence of involuntary movement on limbs prompting another hospital admission. Further imaging revealed hypodensities in the corpus callosum and left caudate nucleus. Electroencephalogram showed epileptiform discharges on the frontal lobe. The patient was managed as choreic-hemiballismus movement disorder with post stroke seizure, and treated with combined oral hypoglyemics and insulin, Selective serotonin re-uptake inhibitors, anti-seizure medications, and was discharged with improved involuntary movements after control of blood sugar levels during follow-up.

Conclusion. Nonketotic-Hyperglycemic chorea-hemiballismus is a rare and poorly understood neurologic complication of Diabetes Mellitus. Control of blood glucose combined with pharmacologic therapy to control involuntary movements remain superior in management of symptoms with good prognosis.

Keywords. Hemichorea, Non-ketotic hyperglycemia, Diabetic striopathy, Diabetic hemichorea, Chorea hyperglycemia basal ganglia syndrome

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