Hyperglycemia Hemichorea Mimicking Status Epilepticus: A Diagnostic Challenge

Introduction: Hyperglycemia can present as hemichorea which can mimic status epilepticus, especially on first presentation. Treatment typically involves control of the hyperglycemia, with resolution of hemichorea over days. However, in some cases, anti-chorea medications may be required.


Description: A 66-year-old gentleman with no past medical history presented to the emergency department with 2 months of polyuria and polydipsia and giddiness. He was noted to be confused on arrival and reported by his family to have altered mental state for the last two days. His family reported him to have recurrent jerking of his limbs which spontaneously aborted. En-route to hospital he had another 2 episodes of seizure. On examination he was noted to have generalized tonic-clonic seizures with jerking of limbs and uprolling of eyes. He was given a total of 12mg of intravenous lorazepam with abortion of seizure. His venous blood glucose was > 33.0 mmol/L on arrival. He was electively intubated and transferred to the intensive care unit for airway protection in view of drowsiness and neurological state monitoring in view of status epilepticus. Electroencephalography did not show epileptiform discharges. He had a computed topography of brain done which showed hyperdensity involving left caudate nucleus and left basal ganglia, consistent with a clinical presentation of hyperglycemic hemichorea rather than status epilepticus. He was initially started on levetiracetam but subsequently discontinued. Control of his blood glucose resulted in clinical improvement, and he did not need any anti-epileptic nor anti-chorea drug on discharge. He was subsequently followed up in the neurology clinic with no further recurrence of symptoms.


Discussion: Hyperglycemic hemichorea can mimic status epilepticus and one must maintain a high index of suspicion for the possibility of hyperglycemic hemichorea if the blood glucose is high as the mainstay of management is glucose control. Over-administration of benzodiazepines to abort the “seizure” acutely may result in over-sedation and complications which may necessitate an intensive care unit admission which could have been avoided. In some cases, dopamine receptor blockers and benzodiazepines may be required if symptoms of hemichorea persist.