Relato de caso: Hemibalismo-hemicoreia como primeira manifestação do Diabetes Mellitus tipo 2.

Abstract

Introduction: Non-ketotic hyperglycemia is a rare cause of hemiballismus-hemichorea, with some cases noted in literature as the first manifestation of Type 2 Diabetes Mellitus (DM2). Case Report: A 77-year-old male with a history of hypertension and hypothyroidism was admitted to the hospital due to acute involuntary hyperkinetic movements in the neck and left upper limb, along with symptoms of polydipsia and urinary frequency. Upon admission, he was diagnosed with DM2, evidenced by high capillary blood glucose levels and a glycated hemoglobin of 14.7%. Initial examinations, including head tomography and arterial blood gas analysis, were normal. After eight days of hospitalization and effective glycemic control through insulin therapy, the hemiballismus-hemichorea condition completely regressed. Discussion: Neurological conditions and movement disorders are not typical initial indicators of DM2. Ballismus is defined as a rare hyperkinetic movement disorder involving involuntary, violent, and high-amplitude movements, primarily affecting proximal and axial appendicular muscles. Hemiballismus is linked to lesions or functional inactivation of the subthalamic nucleus, which reduces neuronal activity in the globus pallidus. In cases of non-ketotic hyperglycemia, a shift to anaerobic metabolism may lead to decreased GABA levels, thereby increasing dopaminergic activity. Conclusion: This report underscores the significance of early recognition of involuntary movement disorders as potential initial manifestations of DM2, which can enhance recovery through proper glycemic management.