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Título

Atypical presentation of the Chorea associated with prime diagnosis of diabetes: a case report

RESUMO

Case presentation: A 71-year-old female patient presents with choric movements in the left hemibody that has initiated 3 years before after a hyperglycemic episode diagnosed as Diabetes Mellitus (DM). This diagnosis of DM happened after an episode of impaired strenght of the lower limbs, mental disorder and whole body paresthesia, that has led her to seek for an emergency servicewhere it was diagnosed the hyperglycemic condition (522mg/l). Head CT scan and the other laboratorial exams showed no changes. She was hospitalized for one week and after a glycemic control she maintained outpatient treatment with metformin. Despite of the treatment of the high serum glucosis, the patient maintained choric movement lasting more than three years. She used Aripiprazole, that was switched to Risperidona and after that it was noticed significant improvement of chorea.
Discussion: The chorea is a hyperkinetic movement disturb presenting rapid and unpredicted muscle contractions. It affects mainly the distal portion of the limbs, besides the face and the torso and can be classified as hereditary, as in Huntington Disease, or acquired, when associated with other etiologies as traumatic brain injuries, drugs and metabolic changes (hyperglycemia among others). According to literature, metabolic features appears as second main etiology of acute chorea, present in 30% of all cases. Generally there is slow remission of the chorea after glycemic control and abnormal movements may last for more than one year.
Final Considerations: This case shows the association between an acute choric event after hyperglycemia that remains even after glycemic stabilization, reinforcing the non-remission of the symptoms acutely after the etiological treatment. Furthermore, it is relevant to perform an adequate etiological investigation in order to have early recognition of the cause and prompt treatment avoiding additional complications.

Palavras Chave

chorea; hyperkinetic movement disturb; hyperglycemia; diabetes