Acute hemichorea in a newly diagnosed type II diabetes patient: a diagnostic challenge in resource-limited setting: a case report

Flora Ruhangisa, Henry Stephen, Jacob Senkondo, Amos Mwasamwaja, Said Kanenda, Saleh Mbarak, Nyasatu Chamba, Kajiru Kilonzo, William Howlett, Isaack Lyaruu and Elichilia Shao
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Chorea is a rare complication of uncontrolled type II diabetes. We report for the first time in Tanzania a case of type II diabetes presenting with a hyperglycaemia-induced hemichorea.

Case presentation

A 58-year-old Tanzanian chagga by tribe with a body mass index of 28 kg/m2 and newly diagnosed type II diabetes presented with polydipsia and involuntary movements of the right upper limb for 4 days. His plasma glucose was 549 mg/dl and glycated haemoglobin was 18.9 %. His movements were exaggerated by attempts to use his right hand. The rest of his neurological assessment was unremarkable. Other laboratory findings including calcium were within the normal range. A computed tomography scan of the brain was essentially normal except for age-related atrophy. There was no significant ketonuria on urine dipstick testing. We treated the patient’s hyperglycaemia with intravenous insulin and the dystonia disappeared within 5 days.


Hemichorea is among the rare complications of hyperglycaemia-induced involuntary movements. Hyperglycaemia should be considered as a differential diagnosis for patients with type II diabetes mellitus presenting with hemichorea upon clinical assessment.