Managing Hemiballismus Hemichorea Caused by Hyperglycemia in an Emergency Department

Chorea, which is a common kind of uncontrollable movement disease, chorea is caused by dysfunctional neural networks that connect the basal ganglia with the frontal cortex. If a patient complains of chorea, a complete medical history is required to rule out other possible causes, including infection with group A beta-hemolytic streptococcus (GABHS), a history of drug use, as well as the patient's age at start and course (acute or insidious). Static chorea may be caused by structural or chemical injury to the basal ganglia or by benign hereditary chorea, both of which are associated with neurodegenerative illnesses. It is also necessary to conduct a neurological examination that includes an evaluation of the distribution and features of chorea. Nonketotic hyperglycemia is a common cause of acute chorea. In addition to hemichorea, hyperglycemia may also produce chorea that is widespread. Patients with hyperglycemia that fit the normal description have been shown to have an unusual symptom of uncontrolled high hyperglycemia: hyperglycemia-induced hemiballismus hemichorea (HIHH). Even if all patients present with abnormal, hyperglycemic nonketotic chorea, the differential diagnosis should be considered. Dopamine blockers, tetrabenazine, and topiramate are used to treat HIHH patients who do not respond to hyperglycemia treatment.