A 63-year-old aunt suddenly started dancing and couldn't stop. It turned out to be caused by this common disease...

Expert in this article: Yang Chao, MD, attending physician at the Rocket Force Special Medical Center

Reviewer of this article: Chen Haixu, Deputy Director and Master Supervisor of the Second Medical Center of PLA General Hospital

Have you heard of "non-ketotic hyperglycemic hemichorea"? It's a long and uncommon name, but it's recently become a hot topic.

Recently, a 63-year-old woman named Wang from Xi'an suddenly started twisting her body while chatting with her daughter at home. She would occasionally swing her left arm, draw circles on the ground with her left leg, and smack her lips. After seeing a doctor, it was found that her blood sugar level was abnormally high. She was eventually diagnosed with non-ketotic hyperglycemic hemichorea.

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Many people have a hard time connecting high blood sugar and uncontrolled dancing. What exactly is non-ketotic hyperglycemic hemichorea?

Hemichorea associated with non-ketotic hyperglycaemia (HC-NH) was first proposed by Bedwell in 1960. Its incidence is less than 1/100,000 and is more common in elderly women. So far, more than 100 cases have been reported worldwide, 80% of which are distributed in Asia, and are mostly seen in diabetic patients with poor blood sugar control.

Nonketotic hyperglycemic hemichorea

What is the cause?

Hyperglycemia is the main cause of non-ketotic hyperglycemic hemichorea, but the specific pathogenesis is still unclear. Diabetes can cause systemic microcirculatory disorders, and typical changes are:

Hyperglycemia can increase blood viscosity, causing diffuse small vessel disease and causing ischemia and hypoxia of brain tissue;

Hyperglycemia can aggravate damage to the blood-brain barrier;

High blood sugar is easily accompanied by hyperosmotic syndrome, which damages the immune system and increases the chance of infection;

Hyperglycemia can aggravate cerebral vasospasm.

Nonketotic hyperglycemic hemichorea

What are the clinical manifestations?

Patients often present with acute or subacute onset, manifested by rapid, irregular and involuntary dance-like movements of one or both limbs, as well as abnormal facial expressions such as squinting, smacking lips, sticking out the tongue, difficulty opening the mouth, and jaw shaking. Most of the movements occur on one side, and are generally more severe in the upper limbs.

Choreotypes are purposeless and irregular, appearing when the patient is awake, aggravated by mental tension and emotional excitement, relieved during rest, and disappearing during sleep. The main imaging manifestation of patients is high-density striatum shadows on head CT (MRI T1WI high signal shadows), and some patients have chorea symptoms but no imaging abnormalities.

Nonketotic hyperglycemic hemichorea

How to treat it?

Blood sugar lowering therapy is the basis of this disease, and blood sugar and risk factors related to cerebrovascular disease should be actively controlled. Dopamine receptor antagonists can be used for treatment, and patients can generally be relieved within 6 months. Most patients with non-ketotic hyperglycemic hemichorea have a good prognosis, and only a few patients continue to have chorea-like movements after blood sugar returns to normal.

How do diabetics control blood sugar?

Take medication regularly

Under the guidance of an endocrinologist, use hypoglycemic drugs rationally, take medication regularly, and monitor blood sugar regularly.

Diet control

Rationally adjust the diet structure, pay attention to dietary diversification, take cereals as the staple food, limit the intake of high-fat and high-cholesterol foods, and choose high-quality protein foods such as milk, eggs, lean meat, etc.

Exercise properly and control your weight

Stick to moderate exercise, such as brisk walking, swimming, Tai Chi, etc., and exercise for at least 30 minutes every day.

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