Clinical Images  |   July 2015
Chorea, Hyperglycemia, Basal Ganglia Syndrome
Author Notes
  • From the Department of Radiology at Brookhaven Memorial Hospital Medical Center in Patchogue, NY. 
  •  *Address correspondence to Ezemonye Madu, DO, MPH, 101 Hospital Rd, Department of Radiology, Brookhaven Memorial Hospital Medical Center, Patchogue, NY 11772-4870. E-mail:
Article Information
Imaging / Neuromusculoskeletal Disorders / Clinical Images
Clinical Images   |   July 2015
Chorea, Hyperglycemia, Basal Ganglia Syndrome
The Journal of the American Osteopathic Association, July 2015, Vol. 115, 465. doi:
The Journal of the American Osteopathic Association, July 2015, Vol. 115, 465. doi:
Web of Science® Times Cited: 2
A 67-year-old woman with hypertension, uncontrolled type 2 diabetes mellitus (T2DM), and end-stage renal disease presented to the emergency department with involuntary chorea-form movements involving the right side of her face and her right arm and leg. Fluid-attenuated inversion recovery magnetic resonance image of her brain demonstrated hyperintensity in the lenticular nucleus (image, arrow). Her blood glucose level was 392 mg/dL and hemoglobin A1c was 7.5%. She received insulin, dietary changes, clonidine, hydralazine, hemodialysis, and heparin for chorea, hyperglycemia, basal ganglia syndrome (C-H-BG); T2DM; and stroke. A week after admission, she achieved good glycemic control and was discharged to a rehabilitation facility with residual chorea-type movement. Outpatient follow-up and referrals to an endocrinologist and neurologist were provided. 
Uncontrolled diabetes has many well-known adverse effects and clinical presentations. However, this case highlights the importance of recognizing its infrequent manifestations. Chorea-type movement, hyperglycemia, and basal ganglia changes found on magnetic resonance imaging in patients with uncontrolled T2DM are the hallmarks of C-H-BG.1 Although the pathophysiologic process of this syndrome is unknown, it is vital for physicians to identify C-H-BG as one of the rare and reversible complications of uncontrolled diabetes1-3 to ensure early diagnosis and management and good outcomes. 
Bizet J, Cooper CJ, Quansah R, Rodriguez E, Teleb M, Hernandez GT. Chorea, hyperglycemia, basal ganglia syndrome (C-H-BG) in an uncontrolled diabetic patient with normal glucose levels on presentation. Am J Case Rep. 2014; 15: 143-146. doi:10.12659/AJCR.890179. [CrossRef] [PubMed]
Tan Y, Xin X, Xiao Q, Chen S, Cao L, Tang H. Hemiballism-hemichorea induced by ketotic hyperglycemia: case report with PET study and review of the literature. Transl Neurodegener. 2014; 3: 14. doi:10.1186/2047-9158-3-14. [CrossRef] [PubMed]
Kaseda Y, Yamawaki T, Ikeda J, et al. Amelioration of persistent, non-ketotic hyperglycemia-induced hemichorea by repetitive transcranial magnetic stimulation. Case Rep Neurol. 2013; 5: 1-68. doi:10.1159/000350434. [CrossRef] [PubMed]