A Case of Diabetic Chorea after the Relatively Rapid Improvement of Glycemic Control by Insulin Injection, and the Long-term Follow-up of the Patient's Condition

Abstract

The patient was a 68 year-old man with a 3-year history of type 2 diabetes mellitus who took an oral hypoglycemic agent. He was admitted to our hospital for the initiation of insulin injections because his laboratory data showed a plasma glucose level of 596 mg/dl and an HbA1c level of 14.4 %. The patient's plasma glucose level decreased after the initiation of premixed insulin and he was discharged. A month after the initiation of insulin injections, he developed chorea in the right extremities. A T1-weighted brain MRI detected abnormal high intensity areas in the left putamen. He was diagnosed with diabetic chorea because the MRI findings were consistent with diabetic chorea. The administration of haloperidol 2.25 mg/day was initiated and his symptoms resolved after three days. Haloperidol treatment was discontinued ten months after the improvement of symptoms. The abnormal MRI findings disappeared in a follow up examination after five months after the occurrence of chorea. There was no recurrence of chorea or abnormal MRI findings for seven years. In general, diabetic chorea develops in connection with hyperglycemia. In the present case, however, diabetic chorea was diagnosed during the rapid improvement of the patient's plasma glucose level.