Encephalopathy, Hypoglycemia, and Flailing Extremities: A Case of Bilateral Chorea–Ballism Associated with Diabetic Ketoacidosis

  • Waldo R Guerrero
  • Michael S. Okun
  • Nikolaus R. McFarland


Background: Hypo/hyperglycemia is a known cause of chorea and hemiballism. The temporallobes, hippocampus, basal ganglia, and substantia nigra are most susceptible to hypoglycemic changes.

Methods: We present a caseof bilateral chorea and bi-ballism accompanied by encephalopathyin the setting of severe hypoglycemia and diabetic ketoacidosis. The patient had brain MRI changes involving both caudate nuclei, temporal lobes, and hippocampi.

Discussion: This case demonstrates the basal ganglia's vulnerability to hypoglycemia and the need for cautious evaluation of involuntary movements when they occur in the setting of encephalopathy.